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Rohrer U, Reischl A, Manninger M, Binder RK, Fiedler L, Gruska M, Altenberger J, Dorr A, Steinwender C, Stuehlinger M, Wonisch M, Zirngast B, Zweiker D, Zirlik A, Scherr D. Cardiovascular Rehabilitation With a WCD-Data From the CR3 Study (Cardiac Rehab Retrospective Review). J Cardiopulm Rehabil Prev 2024; 44:115-120. [PMID: 38032261 PMCID: PMC10913858 DOI: 10.1097/hcr.0000000000000832] [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] [Indexed: 12/01/2023]
Abstract
PURPOSE Patients at risk for sudden cardiac death may temporarily need a wearable cardioverter-defibrillator (WCD). Exercise-based cardiac rehabilitation (CR) has a class I recommendation in patients with cardiac disease. The aim of this study was to evaluate the safety and feasibility of undergoing CR with a WCD. METHODS We performed a retrospective analysis of all patients with a WCD who completed a CR in Austria (2010-2020). RESULTS Patients (n = 55, 60 ± 11 yr, 16% female) with a median baseline left ventricular ejection fraction (LVEF) of 36 (30, 41)% at the start of CR showed a daily WCD wearing duration of 23.4 (22, 24) hr. There were 2848 (8 [1, 26]/patient) automatic alarms and 340 (3 [1, 7]/patient) manual alarms generated. No shocks were delivered by the WCD during the CR period. One patient had recurrent hemodynamically tolerated ventricular tachycardias that were controlled with antiarrhythmic drugs.No severe WCD-associated adverse events occurred during the CR stay of a median 28 (28, 28) d. The fabric garment and the device setting needed to be adjusted in two patients to diminish inappropriate automatic alarms. Left ventricular ejection fraction after CR increased significantly to 42 (30, 44)% ( P < .001). Wearable cardioverter-defibrillator therapy was stopped due to LVEF restitution in 53% of patients. In 36% of patients an implantable cardioverter-defibrillator was implanted, 6% had LVEF improvement after coronary revascularization, one patient received a heart transplantation (2%), two patients discontinued WCD treatment at their own request (4%). CONCLUSION Completing CR is feasible and safe for WCD patients and may contribute positively to the restitution of cardiac function.
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Affiliation(s)
- Ursula Rohrer
- Division of Internal Medicine, Department of Cardiology, Medical University of Graz, Graz, Austria (Drs Rohrer, Manninger, Zweiker, Zirlik, and Scherr and Ms Reischl); Division of Cardiology and Intensive Care, Department of Medicine, Hospital Klinikum Wels-Grieskirchen, Wels, Austria (Dr Binder); Division of Internal Medicine, Cardiology and Nephrology, Department of Medicine, Hospital Wiener Neustadt, Wiener Neustadt, Austria, and Division of Cardiology, Department of Medicine, University Hospital Salzburg, Salzburg, Austria (Dr Fiedler); Department of Science, Innovation and Medical Performance Development of the Austrian Pension Insurance Institution (PVA), Vienna, Austria (Dr Gruska); SKA-Rehabilitation Center Großgmain (PVA), Großgmain, Austria (Dr Altenberger); SKA-Rehabilitation Center St Radegund (PVA), Graz, Austria (Dr Dorr); Division of Cardiology and Intensive Care, Department of Medicine, Kepler University Hospital, Linz, Austria (Dr Steinwender); Division of Cardiology and Angiology, Department of Medicine, University Hospital Innsbruck, Innsbruck, Austria (Dr Stuehlinger); Private Practice for Cardiology and Sports Medicine, Graz, Austria (Dr Wonisch); and Division of Cardiac Surgery, Medical University of Graz, Graz, Austria (Zirngast)
| | - Anja Reischl
- Division of Internal Medicine, Department of Cardiology, Medical University of Graz, Graz, Austria (Drs Rohrer, Manninger, Zweiker, Zirlik, and Scherr and Ms Reischl); Division of Cardiology and Intensive Care, Department of Medicine, Hospital Klinikum Wels-Grieskirchen, Wels, Austria (Dr Binder); Division of Internal Medicine, Cardiology and Nephrology, Department of Medicine, Hospital Wiener Neustadt, Wiener Neustadt, Austria, and Division of Cardiology, Department of Medicine, University Hospital Salzburg, Salzburg, Austria (Dr Fiedler); Department of Science, Innovation and Medical Performance Development of the Austrian Pension Insurance Institution (PVA), Vienna, Austria (Dr Gruska); SKA-Rehabilitation Center Großgmain (PVA), Großgmain, Austria (Dr Altenberger); SKA-Rehabilitation Center St Radegund (PVA), Graz, Austria (Dr Dorr); Division of Cardiology and Intensive Care, Department of Medicine, Kepler University Hospital, Linz, Austria (Dr Steinwender); Division of Cardiology and Angiology, Department of Medicine, University Hospital Innsbruck, Innsbruck, Austria (Dr Stuehlinger); Private Practice for Cardiology and Sports Medicine, Graz, Austria (Dr Wonisch); and Division of Cardiac Surgery, Medical University of Graz, Graz, Austria (Zirngast)
| | - Martin Manninger
- Division of Internal Medicine, Department of Cardiology, Medical University of Graz, Graz, Austria (Drs Rohrer, Manninger, Zweiker, Zirlik, and Scherr and Ms Reischl); Division of Cardiology and Intensive Care, Department of Medicine, Hospital Klinikum Wels-Grieskirchen, Wels, Austria (Dr Binder); Division of Internal Medicine, Cardiology and Nephrology, Department of Medicine, Hospital Wiener Neustadt, Wiener Neustadt, Austria, and Division of Cardiology, Department of Medicine, University Hospital Salzburg, Salzburg, Austria (Dr Fiedler); Department of Science, Innovation and Medical Performance Development of the Austrian Pension Insurance Institution (PVA), Vienna, Austria (Dr Gruska); SKA-Rehabilitation Center Großgmain (PVA), Großgmain, Austria (Dr Altenberger); SKA-Rehabilitation Center St Radegund (PVA), Graz, Austria (Dr Dorr); Division of Cardiology and Intensive Care, Department of Medicine, Kepler University Hospital, Linz, Austria (Dr Steinwender); Division of Cardiology and Angiology, Department of Medicine, University Hospital Innsbruck, Innsbruck, Austria (Dr Stuehlinger); Private Practice for Cardiology and Sports Medicine, Graz, Austria (Dr Wonisch); and Division of Cardiac Surgery, Medical University of Graz, Graz, Austria (Zirngast)
| | - Ronald K. Binder
- Division of Internal Medicine, Department of Cardiology, Medical University of Graz, Graz, Austria (Drs Rohrer, Manninger, Zweiker, Zirlik, and Scherr and Ms Reischl); Division of Cardiology and Intensive Care, Department of Medicine, Hospital Klinikum Wels-Grieskirchen, Wels, Austria (Dr Binder); Division of Internal Medicine, Cardiology and Nephrology, Department of Medicine, Hospital Wiener Neustadt, Wiener Neustadt, Austria, and Division of Cardiology, Department of Medicine, University Hospital Salzburg, Salzburg, Austria (Dr Fiedler); Department of Science, Innovation and Medical Performance Development of the Austrian Pension Insurance Institution (PVA), Vienna, Austria (Dr Gruska); SKA-Rehabilitation Center Großgmain (PVA), Großgmain, Austria (Dr Altenberger); SKA-Rehabilitation Center St Radegund (PVA), Graz, Austria (Dr Dorr); Division of Cardiology and Intensive Care, Department of Medicine, Kepler University Hospital, Linz, Austria (Dr Steinwender); Division of Cardiology and Angiology, Department of Medicine, University Hospital Innsbruck, Innsbruck, Austria (Dr Stuehlinger); Private Practice for Cardiology and Sports Medicine, Graz, Austria (Dr Wonisch); and Division of Cardiac Surgery, Medical University of Graz, Graz, Austria (Zirngast)
| | - Lukas Fiedler
- Division of Internal Medicine, Department of Cardiology, Medical University of Graz, Graz, Austria (Drs Rohrer, Manninger, Zweiker, Zirlik, and Scherr and Ms Reischl); Division of Cardiology and Intensive Care, Department of Medicine, Hospital Klinikum Wels-Grieskirchen, Wels, Austria (Dr Binder); Division of Internal Medicine, Cardiology and Nephrology, Department of Medicine, Hospital Wiener Neustadt, Wiener Neustadt, Austria, and Division of Cardiology, Department of Medicine, University Hospital Salzburg, Salzburg, Austria (Dr Fiedler); Department of Science, Innovation and Medical Performance Development of the Austrian Pension Insurance Institution (PVA), Vienna, Austria (Dr Gruska); SKA-Rehabilitation Center Großgmain (PVA), Großgmain, Austria (Dr Altenberger); SKA-Rehabilitation Center St Radegund (PVA), Graz, Austria (Dr Dorr); Division of Cardiology and Intensive Care, Department of Medicine, Kepler University Hospital, Linz, Austria (Dr Steinwender); Division of Cardiology and Angiology, Department of Medicine, University Hospital Innsbruck, Innsbruck, Austria (Dr Stuehlinger); Private Practice for Cardiology and Sports Medicine, Graz, Austria (Dr Wonisch); and Division of Cardiac Surgery, Medical University of Graz, Graz, Austria (Zirngast)
| | - Michael Gruska
- Division of Internal Medicine, Department of Cardiology, Medical University of Graz, Graz, Austria (Drs Rohrer, Manninger, Zweiker, Zirlik, and Scherr and Ms Reischl); Division of Cardiology and Intensive Care, Department of Medicine, Hospital Klinikum Wels-Grieskirchen, Wels, Austria (Dr Binder); Division of Internal Medicine, Cardiology and Nephrology, Department of Medicine, Hospital Wiener Neustadt, Wiener Neustadt, Austria, and Division of Cardiology, Department of Medicine, University Hospital Salzburg, Salzburg, Austria (Dr Fiedler); Department of Science, Innovation and Medical Performance Development of the Austrian Pension Insurance Institution (PVA), Vienna, Austria (Dr Gruska); SKA-Rehabilitation Center Großgmain (PVA), Großgmain, Austria (Dr Altenberger); SKA-Rehabilitation Center St Radegund (PVA), Graz, Austria (Dr Dorr); Division of Cardiology and Intensive Care, Department of Medicine, Kepler University Hospital, Linz, Austria (Dr Steinwender); Division of Cardiology and Angiology, Department of Medicine, University Hospital Innsbruck, Innsbruck, Austria (Dr Stuehlinger); Private Practice for Cardiology and Sports Medicine, Graz, Austria (Dr Wonisch); and Division of Cardiac Surgery, Medical University of Graz, Graz, Austria (Zirngast)
| | - Johann Altenberger
- Division of Internal Medicine, Department of Cardiology, Medical University of Graz, Graz, Austria (Drs Rohrer, Manninger, Zweiker, Zirlik, and Scherr and Ms Reischl); Division of Cardiology and Intensive Care, Department of Medicine, Hospital Klinikum Wels-Grieskirchen, Wels, Austria (Dr Binder); Division of Internal Medicine, Cardiology and Nephrology, Department of Medicine, Hospital Wiener Neustadt, Wiener Neustadt, Austria, and Division of Cardiology, Department of Medicine, University Hospital Salzburg, Salzburg, Austria (Dr Fiedler); Department of Science, Innovation and Medical Performance Development of the Austrian Pension Insurance Institution (PVA), Vienna, Austria (Dr Gruska); SKA-Rehabilitation Center Großgmain (PVA), Großgmain, Austria (Dr Altenberger); SKA-Rehabilitation Center St Radegund (PVA), Graz, Austria (Dr Dorr); Division of Cardiology and Intensive Care, Department of Medicine, Kepler University Hospital, Linz, Austria (Dr Steinwender); Division of Cardiology and Angiology, Department of Medicine, University Hospital Innsbruck, Innsbruck, Austria (Dr Stuehlinger); Private Practice for Cardiology and Sports Medicine, Graz, Austria (Dr Wonisch); and Division of Cardiac Surgery, Medical University of Graz, Graz, Austria (Zirngast)
| | - Andreas Dorr
- Division of Internal Medicine, Department of Cardiology, Medical University of Graz, Graz, Austria (Drs Rohrer, Manninger, Zweiker, Zirlik, and Scherr and Ms Reischl); Division of Cardiology and Intensive Care, Department of Medicine, Hospital Klinikum Wels-Grieskirchen, Wels, Austria (Dr Binder); Division of Internal Medicine, Cardiology and Nephrology, Department of Medicine, Hospital Wiener Neustadt, Wiener Neustadt, Austria, and Division of Cardiology, Department of Medicine, University Hospital Salzburg, Salzburg, Austria (Dr Fiedler); Department of Science, Innovation and Medical Performance Development of the Austrian Pension Insurance Institution (PVA), Vienna, Austria (Dr Gruska); SKA-Rehabilitation Center Großgmain (PVA), Großgmain, Austria (Dr Altenberger); SKA-Rehabilitation Center St Radegund (PVA), Graz, Austria (Dr Dorr); Division of Cardiology and Intensive Care, Department of Medicine, Kepler University Hospital, Linz, Austria (Dr Steinwender); Division of Cardiology and Angiology, Department of Medicine, University Hospital Innsbruck, Innsbruck, Austria (Dr Stuehlinger); Private Practice for Cardiology and Sports Medicine, Graz, Austria (Dr Wonisch); and Division of Cardiac Surgery, Medical University of Graz, Graz, Austria (Zirngast)
| | - Clemens Steinwender
- Division of Internal Medicine, Department of Cardiology, Medical University of Graz, Graz, Austria (Drs Rohrer, Manninger, Zweiker, Zirlik, and Scherr and Ms Reischl); Division of Cardiology and Intensive Care, Department of Medicine, Hospital Klinikum Wels-Grieskirchen, Wels, Austria (Dr Binder); Division of Internal Medicine, Cardiology and Nephrology, Department of Medicine, Hospital Wiener Neustadt, Wiener Neustadt, Austria, and Division of Cardiology, Department of Medicine, University Hospital Salzburg, Salzburg, Austria (Dr Fiedler); Department of Science, Innovation and Medical Performance Development of the Austrian Pension Insurance Institution (PVA), Vienna, Austria (Dr Gruska); SKA-Rehabilitation Center Großgmain (PVA), Großgmain, Austria (Dr Altenberger); SKA-Rehabilitation Center St Radegund (PVA), Graz, Austria (Dr Dorr); Division of Cardiology and Intensive Care, Department of Medicine, Kepler University Hospital, Linz, Austria (Dr Steinwender); Division of Cardiology and Angiology, Department of Medicine, University Hospital Innsbruck, Innsbruck, Austria (Dr Stuehlinger); Private Practice for Cardiology and Sports Medicine, Graz, Austria (Dr Wonisch); and Division of Cardiac Surgery, Medical University of Graz, Graz, Austria (Zirngast)
| | - Markus Stuehlinger
- Division of Internal Medicine, Department of Cardiology, Medical University of Graz, Graz, Austria (Drs Rohrer, Manninger, Zweiker, Zirlik, and Scherr and Ms Reischl); Division of Cardiology and Intensive Care, Department of Medicine, Hospital Klinikum Wels-Grieskirchen, Wels, Austria (Dr Binder); Division of Internal Medicine, Cardiology and Nephrology, Department of Medicine, Hospital Wiener Neustadt, Wiener Neustadt, Austria, and Division of Cardiology, Department of Medicine, University Hospital Salzburg, Salzburg, Austria (Dr Fiedler); Department of Science, Innovation and Medical Performance Development of the Austrian Pension Insurance Institution (PVA), Vienna, Austria (Dr Gruska); SKA-Rehabilitation Center Großgmain (PVA), Großgmain, Austria (Dr Altenberger); SKA-Rehabilitation Center St Radegund (PVA), Graz, Austria (Dr Dorr); Division of Cardiology and Intensive Care, Department of Medicine, Kepler University Hospital, Linz, Austria (Dr Steinwender); Division of Cardiology and Angiology, Department of Medicine, University Hospital Innsbruck, Innsbruck, Austria (Dr Stuehlinger); Private Practice for Cardiology and Sports Medicine, Graz, Austria (Dr Wonisch); and Division of Cardiac Surgery, Medical University of Graz, Graz, Austria (Zirngast)
| | - Manfred Wonisch
- Division of Internal Medicine, Department of Cardiology, Medical University of Graz, Graz, Austria (Drs Rohrer, Manninger, Zweiker, Zirlik, and Scherr and Ms Reischl); Division of Cardiology and Intensive Care, Department of Medicine, Hospital Klinikum Wels-Grieskirchen, Wels, Austria (Dr Binder); Division of Internal Medicine, Cardiology and Nephrology, Department of Medicine, Hospital Wiener Neustadt, Wiener Neustadt, Austria, and Division of Cardiology, Department of Medicine, University Hospital Salzburg, Salzburg, Austria (Dr Fiedler); Department of Science, Innovation and Medical Performance Development of the Austrian Pension Insurance Institution (PVA), Vienna, Austria (Dr Gruska); SKA-Rehabilitation Center Großgmain (PVA), Großgmain, Austria (Dr Altenberger); SKA-Rehabilitation Center St Radegund (PVA), Graz, Austria (Dr Dorr); Division of Cardiology and Intensive Care, Department of Medicine, Kepler University Hospital, Linz, Austria (Dr Steinwender); Division of Cardiology and Angiology, Department of Medicine, University Hospital Innsbruck, Innsbruck, Austria (Dr Stuehlinger); Private Practice for Cardiology and Sports Medicine, Graz, Austria (Dr Wonisch); and Division of Cardiac Surgery, Medical University of Graz, Graz, Austria (Zirngast)
| | - Birgit Zirngast
- Division of Internal Medicine, Department of Cardiology, Medical University of Graz, Graz, Austria (Drs Rohrer, Manninger, Zweiker, Zirlik, and Scherr and Ms Reischl); Division of Cardiology and Intensive Care, Department of Medicine, Hospital Klinikum Wels-Grieskirchen, Wels, Austria (Dr Binder); Division of Internal Medicine, Cardiology and Nephrology, Department of Medicine, Hospital Wiener Neustadt, Wiener Neustadt, Austria, and Division of Cardiology, Department of Medicine, University Hospital Salzburg, Salzburg, Austria (Dr Fiedler); Department of Science, Innovation and Medical Performance Development of the Austrian Pension Insurance Institution (PVA), Vienna, Austria (Dr Gruska); SKA-Rehabilitation Center Großgmain (PVA), Großgmain, Austria (Dr Altenberger); SKA-Rehabilitation Center St Radegund (PVA), Graz, Austria (Dr Dorr); Division of Cardiology and Intensive Care, Department of Medicine, Kepler University Hospital, Linz, Austria (Dr Steinwender); Division of Cardiology and Angiology, Department of Medicine, University Hospital Innsbruck, Innsbruck, Austria (Dr Stuehlinger); Private Practice for Cardiology and Sports Medicine, Graz, Austria (Dr Wonisch); and Division of Cardiac Surgery, Medical University of Graz, Graz, Austria (Zirngast)
| | - David Zweiker
- Division of Internal Medicine, Department of Cardiology, Medical University of Graz, Graz, Austria (Drs Rohrer, Manninger, Zweiker, Zirlik, and Scherr and Ms Reischl); Division of Cardiology and Intensive Care, Department of Medicine, Hospital Klinikum Wels-Grieskirchen, Wels, Austria (Dr Binder); Division of Internal Medicine, Cardiology and Nephrology, Department of Medicine, Hospital Wiener Neustadt, Wiener Neustadt, Austria, and Division of Cardiology, Department of Medicine, University Hospital Salzburg, Salzburg, Austria (Dr Fiedler); Department of Science, Innovation and Medical Performance Development of the Austrian Pension Insurance Institution (PVA), Vienna, Austria (Dr Gruska); SKA-Rehabilitation Center Großgmain (PVA), Großgmain, Austria (Dr Altenberger); SKA-Rehabilitation Center St Radegund (PVA), Graz, Austria (Dr Dorr); Division of Cardiology and Intensive Care, Department of Medicine, Kepler University Hospital, Linz, Austria (Dr Steinwender); Division of Cardiology and Angiology, Department of Medicine, University Hospital Innsbruck, Innsbruck, Austria (Dr Stuehlinger); Private Practice for Cardiology and Sports Medicine, Graz, Austria (Dr Wonisch); and Division of Cardiac Surgery, Medical University of Graz, Graz, Austria (Zirngast)
| | - Andreas Zirlik
- Division of Internal Medicine, Department of Cardiology, Medical University of Graz, Graz, Austria (Drs Rohrer, Manninger, Zweiker, Zirlik, and Scherr and Ms Reischl); Division of Cardiology and Intensive Care, Department of Medicine, Hospital Klinikum Wels-Grieskirchen, Wels, Austria (Dr Binder); Division of Internal Medicine, Cardiology and Nephrology, Department of Medicine, Hospital Wiener Neustadt, Wiener Neustadt, Austria, and Division of Cardiology, Department of Medicine, University Hospital Salzburg, Salzburg, Austria (Dr Fiedler); Department of Science, Innovation and Medical Performance Development of the Austrian Pension Insurance Institution (PVA), Vienna, Austria (Dr Gruska); SKA-Rehabilitation Center Großgmain (PVA), Großgmain, Austria (Dr Altenberger); SKA-Rehabilitation Center St Radegund (PVA), Graz, Austria (Dr Dorr); Division of Cardiology and Intensive Care, Department of Medicine, Kepler University Hospital, Linz, Austria (Dr Steinwender); Division of Cardiology and Angiology, Department of Medicine, University Hospital Innsbruck, Innsbruck, Austria (Dr Stuehlinger); Private Practice for Cardiology and Sports Medicine, Graz, Austria (Dr Wonisch); and Division of Cardiac Surgery, Medical University of Graz, Graz, Austria (Zirngast)
| | - Daniel Scherr
- Division of Internal Medicine, Department of Cardiology, Medical University of Graz, Graz, Austria (Drs Rohrer, Manninger, Zweiker, Zirlik, and Scherr and Ms Reischl); Division of Cardiology and Intensive Care, Department of Medicine, Hospital Klinikum Wels-Grieskirchen, Wels, Austria (Dr Binder); Division of Internal Medicine, Cardiology and Nephrology, Department of Medicine, Hospital Wiener Neustadt, Wiener Neustadt, Austria, and Division of Cardiology, Department of Medicine, University Hospital Salzburg, Salzburg, Austria (Dr Fiedler); Department of Science, Innovation and Medical Performance Development of the Austrian Pension Insurance Institution (PVA), Vienna, Austria (Dr Gruska); SKA-Rehabilitation Center Großgmain (PVA), Großgmain, Austria (Dr Altenberger); SKA-Rehabilitation Center St Radegund (PVA), Graz, Austria (Dr Dorr); Division of Cardiology and Intensive Care, Department of Medicine, Kepler University Hospital, Linz, Austria (Dr Steinwender); Division of Cardiology and Angiology, Department of Medicine, University Hospital Innsbruck, Innsbruck, Austria (Dr Stuehlinger); Private Practice for Cardiology and Sports Medicine, Graz, Austria (Dr Wonisch); and Division of Cardiac Surgery, Medical University of Graz, Graz, Austria (Zirngast)
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Hansen D, Beckers P, Neunhäuserer D, Bjarnason-Wehrens B, Piepoli MF, Rauch B, Völler H, Corrà U, Garcia-Porrero E, Schmid JP, Lamotte M, Doherty P, Reibis R, Niebauer J, Dendale P, Davos CH, Kouidi E, Spruit MA, Vanhees L, Cornelissen V, Edelmann F, Barna O, Stettler C, Tonoli C, Greco E, Pedretti R, Abreu A, Ambrosetti M, Braga SS, Bussotti M, Faggiano P, Takken T, Vigorito C, Schwaab B, Coninx K. Standardised Exercise Prescription for Patients with Chronic Coronary Syndrome and/or Heart Failure: A Consensus Statement from the EXPERT Working Group. Sports Med 2023; 53:2013-2037. [PMID: 37648876 DOI: 10.1007/s40279-023-01909-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/08/2023] [Indexed: 09/01/2023]
Abstract
Whereas exercise training, as part of multidisciplinary rehabilitation, is a key component in the management of patients with chronic coronary syndrome (CCS) and/or congestive heart failure (CHF), physicians and exercise professionals disagree among themselves on the type and characteristics of the exercise to be prescribed to these patients, and the exercise prescriptions are not consistent with the international guidelines. This impacts the efficacy and quality of the intervention of rehabilitation. To overcome these barriers, a digital training and decision support system [i.e. EXercise Prescription in Everyday practice & Rehabilitative Training (EXPERT) tool], i.e. a stepwise aid to exercise prescription in patients with CCS and/or CHF, affected by concomitant risk factors and comorbidities, in the setting of multidisciplinary rehabilitation, was developed. The EXPERT working group members reviewed the literature and formulated exercise recommendations (exercise training intensity, frequency, volume, type, session and programme duration) and safety precautions for CCS and/or CHF (including heart transplantation). Also, highly prevalent comorbidities (e.g. peripheral arterial disease) or cardiac devices (e.g. pacemaker, implanted cardioverter defibrillator, left-ventricular assist device) were considered, as well as indications for the in-hospital phase (e.g. after coronary revascularisation or hospitalisation for CHF). The contributions of physical fitness, medications and adverse events during exercise testing were also considered. The EXPERT tool was developed on the basis of this evidence. In this paper, the exercise prescriptions for patients with CCS and/or CHF formulated for the EXPERT tool are presented. Finally, to demonstrate how the EXPERT tool proposes exercise prescriptions in patients with CCS and/or CHF with different combinations of CVD risk factors, three patient cases with solutions are presented.
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Affiliation(s)
- Dominique Hansen
- Heart Centre Hasselt, Jessa Hospital, Hasselt, Belgium.
- UHasselt, BIOMED (Biomedical Research Institute) and REVAL (Rehabilitation Research Centre) (REVAL/BIOMED), Hasselt University, Agoralaan Building A, 3590, Diepenbeek, Belgium.
| | - Paul Beckers
- Department of Cardiology, Antwerp University Hospital, Edegem, Belgium
- Translational Pathophysiological Research, Antwerp University, Antwerp, Belgium
| | - Daniel Neunhäuserer
- Sport and Exercise Medicine Division, Department of Medicine, University of Padova, Padua, Italy
| | - Birna Bjarnason-Wehrens
- Department of Preventive and Rehabilitative Sport and Exercise Medicine, Institute for Cardiology and Sports Medicine, German Sports University, Cologne, Germany
| | - Massimo F Piepoli
- Clinical Cardiology, IRCCS Policlinico San Donato, Milan, Italy
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Bernhard Rauch
- Institut für Herzinfarktforschung Ludwigshafen, Ludwigshafen am Rhein/Stiftung Institut für Herzinfarktforschung Ludwigshafen, Ludwigshafen am Rhein/Zentrum für Ambulante Rehabilitation, ZAR Trier, Trier, Germany
| | - Heinz Völler
- Department of Cardiology, Klinik am See, Rüdersdorf, Germany
- Center of Rehabilitation Research, University of Potsdam, Potsdam, Germany
| | - Ugo Corrà
- Cardiologic Rehabilitation Department, Istituti Clinici Scientifici Salvatore Maugeri, SPA, SB, Scientific Institute of di Veruno, IRCCS, Veruno, NO, Italy
| | | | - Jean-Paul Schmid
- Department of Cardiology, Clinic Barmelweid, Barmelweid, Switzerland
| | | | | | - Rona Reibis
- Cardiological Outpatient Clinics at the Park Sanssouci, Potsdam, Germany
| | - Josef Niebauer
- Institute of Sports Medicine, Prevention and Rehabilitation, Research Institute of Molecular Sports Medicine and Rehabilitation, Rehab-Center Salzburg, Ludwig Boltzmann Institute for Digital Health and Prevention, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Paul Dendale
- Heart Centre Hasselt, Jessa Hospital, Hasselt, Belgium
- UHasselt, BIOMED (Biomedical Research Institute) and REVAL (Rehabilitation Research Centre) (REVAL/BIOMED), Hasselt University, Agoralaan Building A, 3590, Diepenbeek, Belgium
| | - Constantinos H Davos
- Cardiovascular Research Laboratory, Biomedical Research Foundation, Academy of Athens, Athens, Greece
| | - Evangelia Kouidi
- Laboratory of Sports Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Martijn A Spruit
- UHasselt, BIOMED (Biomedical Research Institute) and REVAL (Rehabilitation Research Centre) (REVAL/BIOMED), Hasselt University, Agoralaan Building A, 3590, Diepenbeek, Belgium
- Department of Research & Education; CIRO+, Centre of Expertise for Chronic Organ Failure, Horn/Department of Respiratory Medicine, Maastricht University Medical Centre, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht, The Netherlands
| | - Luc Vanhees
- Research Group of Cardiovascular Rehabilitation, Department of Rehabilitation Sciences, Faculty of Kinesiology and Rehabilitation Sciences, KU Leuven, Leuven, Belgium
- Department Rehabilitation Sciences, University Leuven, Leuven, Belgium
| | - Véronique Cornelissen
- Research Group of Cardiovascular Rehabilitation, Department of Rehabilitation Sciences, Faculty of Kinesiology and Rehabilitation Sciences, KU Leuven, Leuven, Belgium
- Department Rehabilitation Sciences, University Leuven, Leuven, Belgium
| | - Frank Edelmann
- Department of Cardiology, Angiology and Intensive Care, Deutsches Herzzentrum der Charité (DHZC), Charité-Universitaetsmedizin Berlin, Campus Virchow Klinikum, Berlin, Germany
| | - Olga Barna
- Family Medicine Department, National O.O. Bogomolets Medical University, Kiev, Ukraine
| | - Christoph Stettler
- Division of Endocrinology, Diabetes and Clinical Nutrion, University Hospital/Inselspital, Bern, Switzerland
| | - Cajsa Tonoli
- Movement Control and Neuroplasticity Research Group, Department of Movement Sciences, Faculty of Movement and Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | | | | | - Ana Abreu
- Centre of Cardiovascular RehabilitationCardiology Department, Centro Universitário Hospitalar Lisboa Norte & Faculdade de Medicina da Universidade Lisboa/Instituto Saúde Ambiental & Instituto Medicina Preventiva, Faculdade Medicina da Universidade Lisboa/CCUL/CAML, Lisbon, Portugal
| | - Marco Ambrosetti
- Cardiovascular Rehabilitation Unit, Le Terrazze Clinic, Cunardo, Italy
| | | | - Maurizio Bussotti
- Unit of Cardiorespiratory Rehabilitation, Instituti Clinici Maugeri, IRCCS, Institute of Milan, Milan, Italy
| | | | - Tim Takken
- Division of Pediatrics, Child Development & Exercise Center, Wilhelmina Children's Hospital, UMC Utrecht, Utrecht, The Netherlands
| | - Carlo Vigorito
- Department of Translational Medical Sciences, Internal Medicine and Cardiac Rehabilitation, University of Naples Federico II, Naples, Italy
| | - Bernhard Schwaab
- Curschmann Clinic, Rehabilitation Center for Cardiology, Vascular Diseases and Diabetes, Timmendorfer Strand/Medical Faculty, University of Lübeck, Lübeck, Germany
| | - Karin Coninx
- UHasselt, Faculty of Sciences, Human-Computer Interaction and eHealth, Hasselt University, Hasselt, Belgium
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Kuhara S, Matsugaki R, Imamura H, Itoh H, Oginosawa Y, Araki M, Fushimi K, Matsuda S, Saeki S. A survey of the implementation rate of cardiac rehabilitation for patients with heart disease undergoing device implantation in Japan. J Arrhythm 2022; 38:1049-1055. [DOI: 10.1002/joa3.12792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 09/26/2022] [Accepted: 10/15/2022] [Indexed: 11/07/2022] Open
Affiliation(s)
- Satoshi Kuhara
- Rehabilitation Center of University Hospital University of Occupational and Environmental Health Kitakyushu Japan
| | - Ryutaro Matsugaki
- Department of Preventive Medicine and Community Health University of Occupational and Environmental Health Kitakyushu Japan
| | - Hanaka Imamura
- Department of Preventive Medicine and Community Health University of Occupational and Environmental Health Kitakyushu Japan
| | - Hideaki Itoh
- Department of Rehabilitation Medicine University of Occupational and Environmental Health Kitakyushu Japan
| | - Yasushi Oginosawa
- Department of Health Policy and Informatics Tokyo Medical and Dental University Graduate School Tokyo Japan
| | - Masaru Araki
- Department of Health Policy and Informatics Tokyo Medical and Dental University Graduate School Tokyo Japan
| | - Kiyohide Fushimi
- Second Department of Internal Medicine University of Occupational and Environmental Health Kitakyushu Japan
| | - Shinya Matsuda
- Department of Preventive Medicine and Community Health University of Occupational and Environmental Health Kitakyushu Japan
| | - Satoru Saeki
- Department of Rehabilitation Medicine University of Occupational and Environmental Health Kitakyushu Japan
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4
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Koike A, Sobue Y, Kawai M, Yamamoto M, Banno Y, Harada M, Kiyono K, Watanabe E. Safety and feasibility of a telemonitoring-guided exercise program in patients receiving cardiac resynchronization therapy. Ann Noninvasive Electrocardiol 2021; 27:e12926. [PMID: 34863002 PMCID: PMC8916563 DOI: 10.1111/anec.12926] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Revised: 11/17/2021] [Accepted: 11/22/2021] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Telerehabilitation is an alternative clinic-based rehabilitation. A remote monitoring (RM) system attached to a cardiac rhythm device can collect physiological data and the device function. This study aimed to evaluate the safety and feasibility of telerehabilitation supervised by an RM in patients receiving cardiac resynchronization therapy (CRT). METHODS A single group pre-post exercise program was implemented for 3 months in 18 CRT recipients. The exercise regimen consisted of walking a prescribed number of steps based on a 6-min walk distance (6MWD) achieved at baseline. The patients were asked to exercise 3 to 5 times per week for up to 30 min per session, wearing an accelerometer to document the number of steps taken. The safety was assessed by the heart failure hospitalizations and all-cause death. The feasibility was measured by the improvement in the quality of life (QOL) using the EuroQol 5 dimensions, and daily active time measured by the CRT, 6MWD, B-type natriuretic peptide (BNP) level, and left ventricular ejection fraction (LVEF). RESULTS No patients had heart failure hospitalizations or died. No patients had any ventricular tachyarrhythmias. One patient needed to suspend the exercise due to signs of exacerbated heart failure by the RM. Compared to baseline, there were significant improvements in the QOL (-0.037, p < .05), active time (1.12%/day, p < .05), and 6MWD (11 m, p < .001), but not the BNP (-32.4 pg/ml, p = .07) or LVEF (0.28%, p = .55). CONCLUSIONS Three months of RM-guided walking exercise in patients with CRT significantly increased the QOL, active time, and exercise capacity without any adverse effects.
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Affiliation(s)
- Asami Koike
- Department of Laboratory MedicineFujita Health University HospitalToyoakeJapan
| | - Yoshihiro Sobue
- Division of CardiologyDepartment of Internal MedicineFujita Health University Bantane HospitalNagoyaJapan
| | - Mayumi Kawai
- Department of CardiologyFujita Health University School of MedicineToyoakeJapan
| | - Masaru Yamamoto
- Department of Laboratory MedicineFujita Health University HospitalToyoakeJapan
| | - Yukina Banno
- Department of Laboratory MedicineFujita Health University HospitalToyoakeJapan
| | - Mashide Harada
- Department of CardiologyFujita Health University School of MedicineToyoakeJapan
| | - Ken Kiyono
- Division of BioengineeringGraduate School of Engineering ScienceOsaka UniversityToyonakaJapan
| | - Eiichi Watanabe
- Division of CardiologyDepartment of Internal MedicineFujita Health University Bantane HospitalNagoyaJapan
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5
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Sopek Merkaš I, Slišković AM, Lakušić N. Current concept in the diagnosis, treatment and rehabilitation of patients with congestive heart failure. World J Cardiol 2021; 13:183-203. [PMID: 34367503 PMCID: PMC8326153 DOI: 10.4330/wjc.v13.i7.183] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 05/20/2021] [Accepted: 07/09/2021] [Indexed: 02/06/2023] Open
Abstract
Heart failure (HF) is a major public health problem with a prevalence of 1%-2% in developed countries. The underlying pathophysiology of HF is complex and as a clinical syndrome is characterized by various symptoms and signs. HF is classified according to left ventricular ejection fraction (LVEF) and falls into three groups: LVEF ≥ 50% - HF with preserved ejection fraction (HFpEF), LVEF < 40% - HF with reduced ejection fraction (HFrEF), LVEF 40%-49% - HF with mid-range ejection fraction. Diagnosing HF is primarily a clinical approach and it is based on anamnesis, physical examination, echocardiogram, radiological findings of the heart and lungs and laboratory tests, including a specific markers of HF - brain natriuretic peptide or N-terminal pro-B-type natriuretic peptide as well as other diagnostic tests in order to elucidate possible etiologies. Updated diagnostic algorithms for HFpEF have been recommended (H2FPEF, HFA-PEFF). New therapeutic options improve clinical outcomes as well as functional status in patients with HFrEF (e.g., sodium-glucose cotransporter-2 - SGLT2 inhibitors) and such progress in treatment of HFrEF patients resulted in new working definition of the term “HF with recovered left ventricular ejection fraction”. In line with rapid development of HF treatment, cardiac rehabilitation becomes an increasingly important part of overall approach to patients with chronic HF for it has been proven that exercise training can relieve symptoms, improve exercise capacity and quality of life as well as reduce disability and hospitalization rates. We gave an overview of latest insights in HF diagnosis and treatment with special emphasize on the important role of cardiac rehabilitation in such patients.
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Affiliation(s)
- Ivana Sopek Merkaš
- Department of Cardiology, Special Hospital for Medical Rehabilitation Krapinske Toplice, Krapinske Toplice 49217, Croatia
| | - Ana Marija Slišković
- Department of Cardiology, University Hospital Centre Zagreb, Zagreb 10000, Croatia
| | - Nenad Lakušić
- Department of Cardiology, Special Hospital for Medical Rehabilitation Krapinske Toplice, Krapinske Toplice 49217, Croatia
- Department of Clinical Medicine, Faculty of Dental Medicine and Health Osijek, Osijek 31000, Croatia
- Department of Internal Medicine, Family Medicine and History of Medicine, Faculty of Medicine Osijek, Osijek 31000, Croatia
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6
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Sassone B, Virzì S, Bertini M, Pasanisi G, Manzoli L, Myers J, Grazzi G, Muser D. Impact of the COVID-19 lockdown on the arrhythmic burden of patients with implantable cardioverter-defibrillators. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2021; 44:1033-1038. [PMID: 34022067 PMCID: PMC8207039 DOI: 10.1111/pace.14280] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Revised: 04/12/2021] [Accepted: 05/16/2021] [Indexed: 12/18/2022]
Abstract
BACKGROUND In Italy, a nationwide full lockdown was declared between March and May 2020 to hinder the novel coronavirus disease 2019 (COVID-19) pandemic. The potential individual health effects of long-term isolation are largely unknown. The current study investigated the arrhythmic consequences of the COVID-19 lockdown in patients with defibrillators (ICDs) living in the province of Ferrara, Italy. METHODS Both the arrhythmias and the delivered ICD therapies as notified by the devices were prospectively collected during the lockdown period (P1) and compared to those occurred during the 10 weeks before the lockdown began (P2) and during the same period in 2019 (P3). Changes in outcome over the three study periods were evaluated for significance using McNemar's test. RESULTS A total of 413 patients were included in the analysis. No differences were found concerning either arrhythmias or shocks or anti-tachycardia pacing. Only the number of patients experiencing non-sustained ventricular tachycardias (NSVTs) during P1 significantly decreased as compared to P2 (p = 0.026) and P3 (p = 0.009). The subgroup analysis showed a significant decrease in NSVTs during P1 for men (vs. P2, p = 0.014; vs. P3, p = 0.040) and younger patients (vs. P2, p = 0.002; vs. P3, p = 0.040) and for ischemic etiology (vs. P2, p = 0.003). No arrhythmic deaths occurred during P1. CONCLUSIONS The complete nationwide lockdown, as declared by the Italian government during the first COVID-19 pandemic peak, did not impact on the incidence of arrhythmias in an urban cohort of patients with ICDs.
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Affiliation(s)
- Biagio Sassone
- Department of Translational Medicine, University of Ferrara, Ferrara, Italy.,Department of Emergency, Division of Cardiology, SS.ma Annunziata Hospital, Ferrara, Italy.,Department of Emergency, Division of Cardiology, Delta Hospital, Ferrara, Italy
| | - Santo Virzì
- Department of Emergency, Division of Cardiology, SS.ma Annunziata Hospital, Ferrara, Italy
| | - Matteo Bertini
- Cardiological Centre, Department of Translational Medicine, University of Ferrara, Ferrara, Italy
| | - Giovanni Pasanisi
- Department of Emergency, Division of Cardiology, Delta Hospital, Ferrara, Italy
| | - Lamberto Manzoli
- Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Jonathan Myers
- Division of Cardiology, VA Palo Alto, Palo Alto, California, USA.,Stanford University School of Medicine, Stanford, California, USA
| | - Giovanni Grazzi
- Centre for Exercise Science and Sport, University of Ferrara, Ferrara, Italy.,Healthy Living for Pandemic Event Protection (HL-PIVOT) Network, Chicago, Illinois, USA
| | - Daniele Muser
- Cardiac Electrophysiology, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Cardiothoracic Department, Udine Civil Hospital, Udine, Italy
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7
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Rauch B, Salzwedel A, Bjarnason-Wehrens B, Albus C, Meng K, Schmid JP, Benzer W, Hackbusch M, Jensen K, Schwaab B, Altenberger J, Benjamin N, Bestehorn K, Bongarth C, Dörr G, Eichler S, Einwang HP, Falk J, Glatz J, Gielen S, Grilli M, Grünig E, Guha M, Hermann M, Hoberg E, Höfer S, Kaemmerer H, Ladwig KH, Mayer-Berger W, Metzendorf MI, Nebel R, Neidenbach RC, Niebauer J, Nixdorff U, Oberhoffer R, Reibis R, Reiss N, Saure D, Schlitt A, Völler H, von Känel R, Weinbrenner S, Westphal R. Cardiac Rehabilitation in German Speaking Countries of Europe-Evidence-Based Guidelines from Germany, Austria and Switzerland LLKardReha-DACH-Part 1. J Clin Med 2021; 10:2192. [PMID: 34069561 PMCID: PMC8161282 DOI: 10.3390/jcm10102192] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Revised: 03/20/2021] [Accepted: 03/23/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Although cardiovascular rehabilitation (CR) is well accepted in general, CR-attendance and delivery still considerably vary between the European countries. Moreover, clinical and prognostic effects of CR are not well established for a variety of cardiovascular diseases. METHODS The guidelines address all aspects of CR including indications, contents and delivery. By processing the guidelines, every step was externally supervised and moderated by independent members of the "Association of the Scientific Medical Societies in Germany" (AWMF). Four meta-analyses were performed to evaluate the prognostic effect of CR after acute coronary syndrome (ACS), after coronary bypass grafting (CABG), in patients with severe chronic systolic heart failure (HFrEF), and to define the effect of psychological interventions during CR. All other indications for CR-delivery were based on a predefined semi-structured literature search and recommendations were established by a formal consenting process including all medical societies involved in guideline generation. RESULTS Multidisciplinary CR is associated with a significant reduction in all-cause mortality in patients after ACS and after CABG, whereas HFrEF-patients (left ventricular ejection fraction <40%) especially benefit in terms of exercise capacity and health-related quality of life. Patients with other cardiovascular diseases also benefit from CR-participation, but the scientific evidence is less clear. There is increasing evidence that the beneficial effect of CR strongly depends on "treatment intensity" including medical supervision, treatment of cardiovascular risk factors, information and education, and a minimum of individually adapted exercise volume. Additional psychologic interventions should be performed on the basis of individual needs. CONCLUSIONS These guidelines reinforce the substantial benefit of CR in specific clinical indications, but also describe remaining deficits in CR-delivery in clinical practice as well as in CR-science with respect to methodology and presentation.
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Affiliation(s)
- Bernhard Rauch
- Institut für Herzinfarktforschung Ludwigshafen, D-67063 Ludwigshafen, Germany
- Zentrum für Ambulante Rehabilitation, ZAR Trier GmbH, D-54292 Trier, Germany
| | - Annett Salzwedel
- Department of Rehabilitation Medicine, Faculty of Health Sciences Brandenburg, University of Potsdam, D-14469 Potsdam, Germany; (A.S.); (S.E.); (H.V.)
| | - Birna Bjarnason-Wehrens
- Institut für Kreislaufforschung und Sportmedizin, Abt. Präventive und rehabilitative Sport- und Leistungsmedizin, Deutsche Sporthochschule Köln, D-50937 Köln, Germany;
| | - Christian Albus
- Department of Psychosomatics and Psychotherapy, Faculty of Medicine, University Hospital, D-50937 Köln, Germany;
| | - Karin Meng
- Institut für Klinische Epidemiologie und Biometrie (IKE-B), Universität Würzburg, D-97078 Würzburg, Germany;
| | | | | | - Matthes Hackbusch
- Institute of Medical Biometry and Informatics (IMBI), University of Heidelberg, D-69120 Heidelberg, Germany; (M.H.); (K.J.); (D.S.)
| | - Katrin Jensen
- Institute of Medical Biometry and Informatics (IMBI), University of Heidelberg, D-69120 Heidelberg, Germany; (M.H.); (K.J.); (D.S.)
| | - Bernhard Schwaab
- Curschmann Klinik Dr. Guth GmbH & Co KG, D-23669 Timmendorfer Strand, Germany;
| | | | - Nicola Benjamin
- Zentrum für Pulmonale Hypertonie, Thorax-Klinik am Universitätsklinikum Heidelberg, D-69126 Heidelberg, Germany; (N.B.); (E.G.)
| | - Kurt Bestehorn
- Institut für Klinische Pharmakologie, Technische Universität Dresden, Fiedlerstraße 42, D-01307 Dresden, Germany;
| | - Christa Bongarth
- Klinik Höhenried gGmbH, Rehabilitationszentrum am Starnberger See, D-82347 Bernried, Germany; (C.B.); (H.-P.E.)
| | - Gesine Dörr
- Alexianer St. Josefs-Krankenhaus Potsdam-Sanssouci, D-14471 Potsdam, Germany;
| | - Sarah Eichler
- Department of Rehabilitation Medicine, Faculty of Health Sciences Brandenburg, University of Potsdam, D-14469 Potsdam, Germany; (A.S.); (S.E.); (H.V.)
| | - Hans-Peter Einwang
- Klinik Höhenried gGmbH, Rehabilitationszentrum am Starnberger See, D-82347 Bernried, Germany; (C.B.); (H.-P.E.)
| | - Johannes Falk
- Deutsche Rentenversicherung Bund (DRV-Bund), D-10709 Berlin, Germany; (J.F.); (S.W.)
| | - Johannes Glatz
- Reha-Zentrum Seehof der Deutschen Rentenversicherung Bund, D-14513 Teltow, Germany;
| | - Stephan Gielen
- Klinikum Lippe, Standort Detmold, D-32756 Detmold, Germany;
| | - Maurizio Grilli
- Universitätsbibliothek, Universitätsmedizin Mannheim, D-68167 Mannheim, Germany;
| | - Ekkehard Grünig
- Zentrum für Pulmonale Hypertonie, Thorax-Klinik am Universitätsklinikum Heidelberg, D-69126 Heidelberg, Germany; (N.B.); (E.G.)
| | - Manju Guha
- Reha-Zentrum am Sendesaal, D-28329 Bremen, Germany;
| | - Matthias Hermann
- Klinik für Kardiologie, Universitätsspital Zürich, Rämistrasse 100, CH-8091 Zürich, Switzerland;
| | - Eike Hoberg
- Wismarstraße 13, D-24226 Heikendorf, Germany;
| | - Stefan Höfer
- Universitätsklinik für Medizinische Psychologie und Psychotherapie, Medizinische Universität Innsbruck, A-6020 Innsbruck, Austria;
| | - Harald Kaemmerer
- Klinik für Angeborene Herzfehler und Kinderkardiologie, Deutsches Herzzentrum München, Klinik der Technischen Universität München, D-80636 München, Germany;
| | - Karl-Heinz Ladwig
- Department of Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, Technische Universität München (TUM) Langerstraße 3, D-81675 Munich, Germany;
| | - Wolfgang Mayer-Berger
- Klinik Roderbirken der Deutschen Rentenversicherung Rheinland, D-42799 Leichlingen, Germany;
| | - Maria-Inti Metzendorf
- Cochrane Metabolic and Endocrine Disorders Group, Institute of General Practice (ifam), Medical Faculty of the Heinrich-Heine University, Werdener Straße. 4, D-40227 Düsseldorf, Germany;
| | - Roland Nebel
- Hermann-Albrecht-Klinik METTNAU, Medizinische Reha-Einrichtungen der Stadt Radolfzell, D-73851 Radolfzell, Germany;
| | - Rhoia Clara Neidenbach
- Institut für Sportwissenschaft, Universität Wien, Auf der Schmelz 6 (USZ I), AU-1150 Wien, Austria;
| | - Josef Niebauer
- Universitätsinstitut für Präventive und Rehabilitative Sportmedizin, Uniklinikum Salzburg Paracelsus Medizinische Privatuniversität, A-5020 Salzburg, Austria;
| | - Uwe Nixdorff
- EPC GmbH, European Prevention Center, Medical Center Düsseldorf, D-40235 Düsseldorf, Germany;
| | - Renate Oberhoffer
- Lehrstuhl für Präventive Pädiatrie, Fakultät für Sport- und Gesundheitswissenschaften, Technische Universität München, D-80992 München, Germany;
| | - Rona Reibis
- Kardiologische Gemeinschaftspraxis Am Park Sanssouci, D-14471 Potsdam, Germany;
| | - Nils Reiss
- Schüchtermann-Schiller’sche Kliniken, Ulmenallee 5-12, D-49214 Bad Rothenfelde, Germany;
| | - Daniel Saure
- Institute of Medical Biometry and Informatics (IMBI), University of Heidelberg, D-69120 Heidelberg, Germany; (M.H.); (K.J.); (D.S.)
| | - Axel Schlitt
- Paracelsus Harz-Klinik Bad Suderode GmbH, D-06485 Quedlinburg, Germany;
| | - Heinz Völler
- Department of Rehabilitation Medicine, Faculty of Health Sciences Brandenburg, University of Potsdam, D-14469 Potsdam, Germany; (A.S.); (S.E.); (H.V.)
- Klinik am See, D-15562 Rüdersdorf, Germany
| | - Roland von Känel
- Klinik für Konsiliarpsychiatrie und Psychosomatik, Universitätsspital Zürich, CH-8091 Zürich, Switzerland;
| | - Susanne Weinbrenner
- Deutsche Rentenversicherung Bund (DRV-Bund), D-10709 Berlin, Germany; (J.F.); (S.W.)
| | - Ronja Westphal
- Herzzentrum Segeberger Kliniken, D-23795 Bad Segeberg, Germany;
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8
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Pedretti RFE, Iliou MC, Israel CW, Abreu A, Miljoen H, Corrà U, Stellbrink C, Gevaert AB, Theuns DA, Piepoli MF, Reibis R, Schmid JP, Wilhelm M, Heidbuchel H, Völler H. Comprehensive multicomponent cardiac rehabilitation in cardiac implantable electronic devices recipients: a consensus document from the European Association of Preventive Cardiology (EAPC; Secondary prevention and rehabilitation section) and European Heart Rhythm Association (EHRA). Europace 2021; 23:1336-1337o. [PMID: 33636723 DOI: 10.1093/europace/euaa427] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 10/25/2020] [Accepted: 11/02/2020] [Indexed: 11/13/2022] Open
Abstract
Cardiac rehabilitation (CR) is a multidisciplinary intervention including patient assessment and medical actions to promote stabilization, management of cardiovascular risk factors, vocational support, psychosocial management, physical activity counselling, and prescription of exercise training. Millions of people with cardiac implantable electronic devices live in Europe and their numbers are progressively increasing, therefore, large subsets of patients admitted in CR facilities have a cardiac implantable electronic device. Patients who are cardiac implantable electronic devices recipients are considered eligible for a CR programme. This is not only related to the underlying heart disease but also to specific issues, such as psychological adaptation to living with an implanted device and, in implantable cardioverter-defibrillator patients, the risk of arrhythmia, syncope, and sudden cardiac death. Therefore, these patients should receive special attention, as their needs may differ from other patients participating in CR. As evidence from studies of CR in patients with cardiac implantable electronic devices is sparse, detailed clinical practice guidelines are lacking. Here, we aim to provide practical recommendations for CR in cardiac implantable electronic devices recipients in order to increase CR implementation, efficacy, and safety in this subset of patients.
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Affiliation(s)
- Roberto F E Pedretti
- Cardiovascular Department, IRCCS MultiMedica, Care and Research Institute, Via Milanese 300, Sesto San Giovanni, Milano 20099, Italy
| | - Marie-Christine Iliou
- Department of Cardiac Rehabilitation and Secondary Prevention, Hôpital Corentin Celton, Assistance Pulique Hopitaux de Paris centre-Universite de Paris, France
| | - Carsten W Israel
- Department of Cardiology, Bethel Clinic, J.W. Goethe University, Frankfurt, Germany
| | - Ana Abreu
- Servico de Cardiologia, Hospital Universitário de Santa Maria/Centro Hospitalar Universitário Lisboa Norte (CHULN), Centro Academico de Medicina de Lisboa (CAML), Centro Cardiovascular da Universidade de Lisboa (CCUL), Faculdade de Medicina, Universidade de Lisboa, Portugal
| | - Hielko Miljoen
- Department of Cardiology, University of Antwerp and University Hospital Antwerp, Antwerp, Belgium
| | - Ugo Corrà
- Department of Cardiac Rehabilitation, ICS Maugeri Care and Research Institute, Veruno, Novara, Italy
| | - Christoph Stellbrink
- Department of Cardiology and Intensive Care Medicine, Klinikum Bielefeld GmbH, Bielefeld, Germany
| | - Andreas B Gevaert
- Department of Cardiology, University of Antwerp and University Hospital Antwerp, Antwerp, Belgium
| | - Dominic A Theuns
- Department of Cardiology, Erasmus MC, Rotterdam, The Netherlands
| | - Massimo F Piepoli
- Heart Failure Unit, G. da Saliceto Hospital, AUSL Piacenza and University of Parma, Parma, Italy
| | - Rona Reibis
- Department of Rehabilitation Medicine, Faculty of Health Sciences Brandenburg, University of Potsdam, Potsdam, Germany.,Cardiac Outpatient Clinic Am Park Sanssouci, Potsdam, Germany
| | - Jean Paul Schmid
- Department of Cardiology, Clinic Barmelweid, Erlinsbach, Switzerland
| | - Matthias Wilhelm
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Hein Heidbuchel
- Department of Cardiology, University of Antwerp and University Hospital Antwerp, Antwerp, Belgium
| | - Heinz Völler
- Department of Rehabilitation Medicine, Faculty of Health Sciences Brandenburg, University of Potsdam, Potsdam, Germany.,Klinik am See, Rehabilitation Centre for Internal Medicine, Rüdersdorf, Germany
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9
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Pedretti RFE, Iliou MC, Israel CW, Abreu A, Miljoen H, Corrà U, Stellbrink C, Gevaert AB, Theuns DA, Piepoli MF, Reibis R, Schmid JP, Wilhelm M, Heidbuchel H, Völler H, Ambrosetti M, Deneke T, Cornelissen V, R Heinzel F, Davos CH, Kudaiberdieva G, Frederix I, Svendsen JH, Hansen D. Comprehensive multicomponent cardiac rehabilitation in cardiac implantable electronic devices recipients: a consensus document from the European Association of Preventive Cardiology (EAPC; Secondary prevention and rehabilitation section) and European Heart Rhythm Association (EHRA). Eur J Prev Cardiol 2021; 28:1736-1752. [PMID: 34038513 DOI: 10.1093/eurjpc/zwaa121] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 10/25/2020] [Accepted: 11/02/2020] [Indexed: 12/13/2022]
Abstract
Cardiac rehabilitation (CR) is a multidisciplinary intervention including patient assessment and medical actions to promote stabilization, management of cardiovascular risk factors, vocational support, psychosocial management, physical activity counselling, and prescription of exercise training. Millions of people with cardiac implantable electronic devices live in Europe and their numbers are progressively increasing, therefore, large subsets of patients admitted in CR facilities have a cardiac implantable electronic device. Patients who are cardiac implantable electronic devices recipients are considered eligible for a CR programme. This is not only related to the underlying heart disease but also to specific issues, such as psychological adaptation to living with an implanted device and, in implantable cardioverter-defibrillator patients, the risk of arrhythmia, syncope, and sudden cardiac death. Therefore, these patients should receive special attention, as their needs may differ from other patients participating in CR. As evidence from studies of CR in patients with cardiac implantable electronic devices is sparse, detailed clinical practice guidelines are lacking. Here, we aim to provide practical recommendations for CR in cardiac implantable electronic devices recipients in order to increase CR implementation, efficacy, and safety in this subset of patients.
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Affiliation(s)
- Roberto F E Pedretti
- Cardiovascular Department, IRCCS MultiMedica, Care and Research Institute, Via Milanese 300, Sesto San Giovanni, Milano 20099, Italy
| | - Marie-Christine Iliou
- Department of Cardiac Rehabilitation and Secondary Prevention, Hôpital Corentin Celton, Assistance Pulique Hopitaux de Paris centre-Universite de Paris, France
| | - Carsten W Israel
- Department of Cardiology, Bethel Clinic, J.W. Goethe University, Frankfurt, Germany
| | - Ana Abreu
- Servico de Cardiologia, Hospital Universitário de Santa Maria/Centro Hospitalar Universitário Lisboa Norte (CHULN), Centro Academico de Medicina de Lisboa (CAML), Centro Cardiovascular da Universidade de Lisboa (CCUL), Faculdade de Medicina, Universidade de Lisboa, Portugal
| | - Hielko Miljoen
- Department of Cardiology, University of Antwerp and University Hospital Antwerp, and Antwerp University, Antwerp, Belgium
| | - Ugo Corrà
- Department of Cardiac Rehabilitation, ICS Maugeri Care and Research Institute, Veruno, Novara, Italy
| | - Christoph Stellbrink
- Department of Cardiology and Intensive Care Medicine, Klinikum Bielefeld GmbH, Bielefeld, Germany
| | - Andreas B Gevaert
- Department of Cardiology, University of Antwerp and University Hospital Antwerp, and Antwerp University, Antwerp, Belgium
| | - Dominic A Theuns
- Department of Cardiology, Erasmus MC, Rotterdam, The Netherlands
| | - Massimo F Piepoli
- Heart Failure Unit, G. da Saliceto Hospital, AUSL Piacenza and University of Parma, Parma, Italy
| | - Rona Reibis
- Department of Rehabilitation Medicine, Faculty of Health Sciences Brandenburg, University of Potsdam, Potsdam, Germany.,Cardiac Outpatient Clinic Am Park Sanssouci, Potsdam, Germany
| | - Jean Paul Schmid
- Department of Cardiology, Clinic Barmelweid, Erlinsbach, Switzerland
| | - Matthias Wilhelm
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Hein Heidbuchel
- Department of Cardiology, University of Antwerp and University Hospital Antwerp, and Antwerp University, Antwerp, Belgium
| | - Heinz Völler
- Department of Rehabilitation Medicine, Faculty of Health Sciences Brandenburg, University of Potsdam, Potsdam, Germany.,Klinik am See, Rehabilitation Centre for Internal Medicine, Rüdersdorf, Germany
| | | | - Marco Ambrosetti
- Cardiovascular Rehabilitation Unit, ASST Crema, Santa Marta Hospital, Rivolta d'Adda, Italy
| | - Thomas Deneke
- Heart Center Rhön-Klinikum Campus Bad Neustadt, Bad Neustadt, Germany
| | - Veronique Cornelissen
- Cardiovascular Exercise Physiology Unit, Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | - Frank R Heinzel
- Department of Cardiology, Charité-Universitaetsmedizin Berlin, Campus Virchow-Klinikum, Berlin, Germany.,Berlin Institute of Health, Berlin, Germany
| | - Constantinos H Davos
- Cardiovascular Research Laboratory, Biomedical Research Foundation, Academy of Athens, Athens, Greece
| | - Gulmira Kudaiberdieva
- SRI of Heart Surgery and Organ Transplantation, Center Scientific Research and Development of Education, Bishkek Kyrgyzstan, Adana, Turkey
| | - Ines Frederix
- Hasselt University, Faculty of Medicine & Life Sciences, Hasselt, Belgium.,Antwerp University, Faculty of Medicine & Health Sciences, Antwerp, Belgium.,Department of Cardiology, Jessa Hospital, Hasselt, Belgium.,Intensive Care Unit, Antwerp University Hospital, Edegem, Belgium
| | - Jesper Hastrup Svendsen
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Dominique Hansen
- Heart Centre Hasselt, Jessa Hospital, Hasselt, Belgium.,Faculty of Medicine and Life Sciences, UHasselt, BIOMED-REVAL-Rehabilitation Research Centre, Hasselt University, Hasselt, Belgium
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Sassone B, Mandini S, Grazzi G, Mazzoni G, Myers J, Pasanisi G. Impact of COVID-19 Pandemic on Physical Activity in Patients With Implantable Cardioverter-Defibrillators. J Cardiopulm Rehabil Prev 2020; 40:285-286. [PMID: 32804796 PMCID: PMC7720812 DOI: 10.1097/hcr.0000000000000539] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
The strict lockdown strategy prompted by the Italian government, to hamper severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) spreading, reduced opportunities to perform physical activity. This study quantified an abrupt and statistically significant reduction by 25% of physical activity in patients with implantable defibrillators, during the forced 40-d in-home confinement. The coronavirus disease-2019 (COVID-19) pandemic has been spreading rapidly worldwide since late January 2020. The strict lockdown strategy prompted by the Italian government, to hamper severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) spreading, has reduced the possibility of performing either outdoor or gym physical activity (PA). This study investigated and quantified the reduction of PA in patients with automatic implantable cardioverter-defibrillators (ICDs) for primary prevention of sudden death.
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Affiliation(s)
- Biagio Sassone
- Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, Ferrara, Italy (Dr Sassone); Department of Emergency, Division of Cardiology, AUSL Ferrara, Ferrara, Italy (Drs Sassone and Pasanisi); Centre for Exercise Science and Sport, University of Ferrara, Ferrara, Italy (Drs Mandini, Grazzi, and Mazzoni); Public Health Department, AUSL Ferrara, Ferrara, Italy (Drs Grazzi and Mazzoni); and Division of Cardiology, VA Palo Alto, Palo Alto, California, and Stanford University School of Medicine, Stanford, California (Dr Myers)
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11
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Langford E, Burnham A, Thompson K, Cook J, Ryan GA. Home-Based Exercise Prescription for Congestive Heart Failure. Strength Cond J 2020. [DOI: 10.1519/ssc.0000000000000524] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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12
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Steinhaus DA, Lubitz SA, Noseworthy PA, Kramer DB. Exercise Interventions in Patients With Implantable Cardioverter-Defibrillators and Cardiac Resynchronization Therapy: A SYSTEMATIC REVIEW AND META-ANALYSIS. J Cardiopulm Rehabil Prev 2019; 39:308-317. [PMID: 31397767 PMCID: PMC6715540 DOI: 10.1097/hcr.0000000000000389] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE Physical activity improves outcomes across a broad spectrum of cardiovascular disease. The safety and effectiveness of exercise-based interventions in patients with implantable cardioverter-defibrillators (ICDs) including cardiac resynchronization therapy defibrillators (CRT-Ds) remain poorly understood. METHODS We identified clinical studies using the following search terms: "implantable cardioverter-defibrillators"; "ICD"; "cardiac resynchronization therapy"; "CRT"; and any one of the following: "activity"; "exercise"; "training"; or "rehabilitation"; from January 1, 2000 to October 1, 2015. Eligible studies were evaluated for design and clinical endpoints. RESULTS A total of 16 studies were included: 8 randomized controlled trials, 5 single-arm trials, 2 observational cohort trials, and 1 randomized crossover trial. A total of 2547 patients were included (intervention groups = 1215 patients, control groups = 1332 patients). Exercise interventions varied widely in character, duration (median 84 d, range: 23-168 d), and follow-up time (median 109 d, range: 23 d to 48 mo). Exercise performance measures were the most common primary endpoints (87.5%), with most studies (81%) demonstrating significant improvement. Implantable cardioverter-defibrillator shocks were uncommon during active exercise intervention, with 6 shocks in 635 patients (0.9%). Implantable cardioverter-defibrillator shocks in follow-up were less common in patients receiving any exercise intervention (15.6% vs 23%, OR = 0.68; 95% CI, 0.48-0.80, P < .001). (Equation is included in full-text article.)O2 peak improved significantly in patients receiving exercise intervention (1.98 vs 0.36 mL/kg/min, P < .001). CONCLUSION In conclusion, exercise interventions in patients with ICDs and CRT-Ds appear safe and effective. Lack of consensus on design and endpoints remains a barrier to broader application to this important patient population.
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Affiliation(s)
- Daniel A. Steinhaus
- Saint Luke’s Mid America Heart Institute, Kansas City, MO
- Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School
| | - Steven A. Lubitz
- Cardiac Arrhythmia Service, Department of Medicine, Massachusetts General Hospital, Harvard Medical School
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13
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Nentwich K, Deneke T. [ICD and sport: a contradiction?]. Herzschrittmacherther Elektrophysiol 2019; 30:156-159. [PMID: 31098777 DOI: 10.1007/s00399-019-0627-x] [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: 04/01/2019] [Accepted: 04/15/2019] [Indexed: 11/26/2022]
Abstract
Implantable defibrillators (ICD) are implanted in patients with congenital or acquired heart diseases with significantly elevated risk for arrhythmogenic cardiac death. The typical profile of these patients ranges from young (competitive) athletes to morbid older patients. European guidelines allow low dynamic and low static physical activity like cricket, golf or yoga. Discussion about individualized or general recommendations for sports activities with an ICD is the main focus of this article.
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Affiliation(s)
- Karin Nentwich
- Abteilung Kardiologie/Elektrophysiologie, Campus Bad Neustadt, Von Guttenbergstr. 11, 97616, Bad Neustadt/Saale, Deutschland.
| | - Thomas Deneke
- Abteilung Kardiologie/Elektrophysiologie, Campus Bad Neustadt, Von Guttenbergstr. 11, 97616, Bad Neustadt/Saale, Deutschland
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14
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Nielsen KM, Zwisler A, Taylor RS, Svendsen JH, Lindschou J, Anderson L, Jakobsen JC, Berg SK. Exercise-based cardiac rehabilitation for adult patients with an implantable cardioverter defibrillator. Cochrane Database Syst Rev 2019; 2:CD011828. [PMID: 30746679 PMCID: PMC6953352 DOI: 10.1002/14651858.cd011828.pub2] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND An effective way of preventing sudden cardiac death is the use of an implantable cardioverter defibrillator (ICD). In spite of the potential mortality benefits of receiving an ICD device, psychological problems experienced by patients after receiving an ICD may negatively impact their health-related quality of life, and lead to increased readmission to hospital and healthcare needs, loss of productivity and employment earnings, and increased morbidity and mortality. Evidence from other heart conditions suggests that cardiac rehabilitation should consist of both exercise training and psychoeducational interventions; such rehabilitation may benefit patients with an ICD. Prior systematic reviews of cardiac rehabilitation have excluded participants with an ICD. A systematic review was therefore conducted to assess the evidence for the use of exercise-based intervention programmes following implantation of an ICD. OBJECTIVES To assess the benefits and harms of exercise-based cardiac rehabilitation programmes (exercise-based interventions alone or in combination with psychoeducational components) compared with control (group of no intervention, treatment as usual or another rehabilitation programme with no physical exercise element) in adults with an ICD. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase and four other databases on 30 August 2018 and three trials registers on 14 November 2017. We also undertook reference checking, citation searching and contacted study authors for missing data. SELECTION CRITERIA We included randomised controlled trials (RCTs) if they investigated exercise-based cardiac rehabilitation interventions compared with no intervention, treatment as usual or another rehabilitation programme. The trial participants were adults (aged 18 years or older), who had been treated with an ICD regardless of type or indication. DATA COLLECTION AND ANALYSIS Two review authors independently extracted data and assessed risk of bias. The primary outcomes were all-cause mortality, serious adverse events and health-related quality of life. The secondary outcomes were exercise capacity, antitachycardia pacing, shock, non-serious adverse events, employment or loss of employment and costs and cost-effectiveness. Risk of systematic errors (bias) was assessed by evaluation of predefined bias risk domains. Clinical and statistical heterogeneity were assessed. Meta-analyses were undertaken using both fixed-effect and random-effects models. We used the GRADE approach to assess the quality of evidence. MAIN RESULTS We identified eight trials published from 2004 to 2017 randomising a total of 1730 participants, with mean intervention duration of 12 weeks. All eight trials were judged to be at overall high risk of bias and effect estimates are reported at the end of the intervention with a follow-up range of eight to 24 weeks.Seven trials reported all-cause mortality, but deaths only occurred in one trial with no evidence of a difference between exercise-based cardiac rehabilitation and control (risk ratio (RR) 1.96, 95% confidence interval (CI) 0.18 to 21.26; participants = 196; trials = 1; quality of evidence: low). There was also no evidence of a difference in serious adverse events between exercise-based cardiac rehabilitation and control (RR 1.05, 95% CI 0.77 to 1.44; participants = 356; trials = 2; quality of evidence: low). Due to the variation in reporting of health-related quality of life outcomes, it was not possible to pool data. However, the five trials reporting health-related quality of life at the end of the intervention, each showed little or no evidence of a difference between exercise-based cardiac rehabilitation and control.For secondary outcomes, there was evidence of a higher pooled exercise capacity (peak VO2) at the end of the intervention (mean difference (MD) 0.91 mL/kg/min, 95% CI 0.60 to 1.21; participants = 1485; trials = 7; quality of evidence: very low) favouring exercise-based cardiac rehabilitation, albeit there was evidence of substantial statistical heterogeneity (I2 = 78%). There was no evidence of a difference in the risk of requiring antitachycardia pacing (RR 1.26, 95% CI 0.84 to 1.90; participants = 356; trials = 2; quality of evidence: moderate), appropriate shock (RR 0.56, 95% CI 0.20 to 1.58; participants = 428; studies = 3; quality of evidence: low) or inappropriate shock (RR 0.60, 95% CI 0.10 to 3.51; participants = 160; studies = 1; quality of evidence: moderate). AUTHORS' CONCLUSIONS Due to a lack of evidence, we were unable to definitively assess the impact of exercise-based cardiac rehabilitation on all-cause mortality, serious adverse events and health-related quality of life in adults with an ICD. However, our findings do provide very low-quality evidence that patients following exercise-based cardiac rehabilitation experience a higher exercise capacity compared with the no exercise control. Further high-quality randomised trials are needed in order to assess the impact of exercise-based cardiac rehabilitation in this population on all-cause mortality, serious adverse events, health-related quality of life, antitachycardia pacing and shock.
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Affiliation(s)
- Kim M Nielsen
- Copenhagen University Hospital, RigshospitaletDepartment of Cardiology, The Heart CentreBlegdamsvej 9CopenhagenDenmark2100
| | - Ann‐Dorthe Zwisler
- Copenhagen University Hospital, RigshospitaletDepartment of Cardiology, The Heart CentreBlegdamsvej 9CopenhagenDenmark2100
| | - Rod S Taylor
- University of Exeter Medical SchoolInstitute of Health ResearchSouth Cloisters, St Luke's Campus, Heavitree RoadExeterUKEX2 4SG
| | - Jesper H Svendsen
- Copenhagen University Hospital, RigshospitaletDepartment of Cardiology, The Heart CentreBlegdamsvej 9CopenhagenDenmark2100
| | - Jane Lindschou
- Department 7812, Rigshospitalet, Copenhagen University HospitalCopenhagen Trial Unit, Centre for Clinical Intervention ResearchBlegdamsvej 9CopenhagenDenmarkDK‐2100
| | - Lindsey Anderson
- University of Exeter Medical SchoolInstitute of Health ResearchSouth Cloisters, St Luke's Campus, Heavitree RoadExeterUKEX2 4SG
| | - Janus C Jakobsen
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Department 7812, Rigshospitalet, Copenhagen University HospitalCochrane Hepato‐Biliary GroupBlegdamsvej 9CopenhagenSjællandDenmarkDK‐2100
- Holbaek HospitalDepartment of CardiologyHolbaekDenmark4300
| | - Selina K Berg
- Copenhagen University Hospital, RigshospitaletDepartment of Cardiology, The Heart CentreBlegdamsvej 9CopenhagenDenmark2100
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Inherited primary arrhythmia disorders: cardiac channelopathies and sports activity. Herz 2018; 45:142-157. [PMID: 29744527 DOI: 10.1007/s00059-018-4706-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2018] [Revised: 03/25/2018] [Accepted: 04/14/2018] [Indexed: 01/02/2023]
Abstract
Sudden cardiac death (SCD) in an apparently healthy individual is a tragedy. It is important to identify the cause of death and to prevent SCD in potentially at-risk family members. Inherited primary arrhythmia disorders are associated with exercise-related SCD. Despite the well-known benefits of exercise, exercise restriction has been a historical mainstay of therapy for these conditions. However, since familiarity with inherited arrhythmia conditions has increased and patients are often children and young adults, it is necessary to reassess the treatment guidelines regarding exercise constraints. The aim of this review is to analyze the risk of exercise-induced SCD in patients with inherited cardiac conditions and explore the challenges faced when advising patients about exercise limitations. We searched for publications on cardiac channelopathies in PubMed with the following medical subject headings (MeSH): "long QT syndrome"; "short QT syndrome"; "Brugada syndrome"; and "catecholaminergic polymorphic ventricular tachycardia". The abstracts of these articles were scanned, and articles of relevance, along with pertinent references, were read in full. The analysis was restricted to reports published in English. The findings of this analysis suggest that exercise with low-to-moderate cardiovascular demand may be possible under regular clinical follow-up in inherited primary arrhythmia disorders. Recent data show that patients with inherited primary arrhythmia disorders are at low risk for events once a comprehensive treatment program has been established. Recreational activity is likely safe for these individuals, with personalized management based on individual patient preferences and priorities.
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Examining Patient Outcome Quality Indicators Based on Wait Time From Referral to Entry Into Cardiac Rehabilitation: A PILOT OBSERVATIONAL STUDY. J Cardiopulm Rehabil Prev 2018; 37:250-256. [PMID: 28169984 DOI: 10.1097/hcr.0000000000000232] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE The purpose of this study was to examine whether meeting the Canadian Cardiovascular Society (CCS) ≤60-day wait time from cardiac rehabilitation (CR) referral to enrollment is associated with CCS patient-level quality indicator outcomes. METHODS This pilot observational study consisted of 69 participants entering CR separated into 2 groups based on wait time (≤60-day, n = 45; >60-day, n = 24). Data were collected at baseline, and 1, 4 (CR completion), 6, and 12 months after baseline. Quality indicators for achieving a 0.5 peak metabolic equivalent (MET) improvement at CR completion, physical activity of 150 min/wk of moderate-vigorous physical activity, and CR adherence were assessed. Depressive symptoms were assessed with the Patient Health Questionnaire. RESULTS Sixty participants completed the study (≤60-day, n = 40; >60-day, n = 20). In the ≤60-day group, 92% of participants achieved the 0.5 MET improvement upon CR completion; whereas 60% of the >60-day group met this criteria (P ≤ .05). For the 150 min/wk of moderate-vigorous physical activity and CR adherence, both groups were not significantly different at any time. Elevated depressive symptoms were initially observed in 45% of participants in the ≤60-day group and 35% in the >60-day group (NS) and decreased to 8% in the ≤60-day group compared with 30% in the >60-day group at 12 months (P ≤ .05). CONCLUSIONS Meeting the CCS 60-day acceptable wait time is associated with improvements in METs and depressive symptoms, but not with physical activity or CR adherence. A larger observational study is warranted to explore patient-level CCS quality indicators during and after CR.
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Ezekowitz JA, O'Meara E, McDonald MA, Abrams H, Chan M, Ducharme A, Giannetti N, Grzeslo A, Hamilton PG, Heckman GA, Howlett JG, Koshman SL, Lepage S, McKelvie RS, Moe GW, Rajda M, Swiggum E, Virani SA, Zieroth S, Al-Hesayen A, Cohen-Solal A, D'Astous M, De S, Estrella-Holder E, Fremes S, Green L, Haddad H, Harkness K, Hernandez AF, Kouz S, LeBlanc MH, Masoudi FA, Ross HJ, Roussin A, Sussex B. 2017 Comprehensive Update of the Canadian Cardiovascular Society Guidelines for the Management of Heart Failure. Can J Cardiol 2017; 33:1342-1433. [PMID: 29111106 DOI: 10.1016/j.cjca.2017.08.022] [Citation(s) in RCA: 433] [Impact Index Per Article: 61.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Revised: 08/28/2017] [Accepted: 08/28/2017] [Indexed: 02/06/2023] Open
Abstract
Since the inception of the Canadian Cardiovascular Society heart failure (HF) guidelines in 2006, much has changed in the care for patients with HF. Over the past decade, the HF Guidelines Committee has published regular updates. However, because of the major changes that have occurred, the Guidelines Committee believes that a comprehensive reassessment of the HF management recommendations is presently needed, with a view to producing a full and complete set of updated guidelines. The primary and secondary Canadian Cardiovascular Society HF panel members as well as external experts have reviewed clinically relevant literature to provide guidance for the practicing clinician. The 2017 HF guidelines provide updated guidance on the diagnosis and management (self-care, pharmacologic, nonpharmacologic, device, and referral) that should aid in day-to-day decisions for caring for patients with HF. Among specific issues covered are risk scores, the differences in management for HF with preserved vs reduced ejection fraction, exercise and rehabilitation, implantable devices, revascularization, right ventricular dysfunction, anemia, and iron deficiency, cardiorenal syndrome, sleep apnea, cardiomyopathies, HF in pregnancy, cardio-oncology, and myocarditis. We devoted attention to strategies and treatments to prevent HF, to the organization of HF care, comorbidity management, as well as practical issues around the timing of referral and follow-up care. Recognition and treatment of advanced HF is another important aspect of this update, including how to select advanced therapies as well as end of life considerations. Finally, we acknowledge the remaining gaps in evidence that need to be filled by future research.
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Affiliation(s)
| | - Eileen O'Meara
- Institut de Cardiologie de Montréal, Université de Montréal, Montréal, Québec, Canada
| | | | | | - Michael Chan
- Edmonton Cardiology Consultants, Edmonton, Alberta, Canada
| | - Anique Ducharme
- Institut de Cardiologie de Montréal, Université de Montréal, Montréal, Québec, Canada
| | | | - Adam Grzeslo
- Hamilton Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | | | | | | | | | - Serge Lepage
- Université de Sherbrooke, Sherbrooke, Québec, Canada
| | | | | | - Miroslaw Rajda
- QEII Health Sciences Centre, Halifax, Nova Scotia, Canada
| | | | - Sean A Virani
- University of British Columbia, Vancouver, British Columbia, Canada
| | | | | | | | | | - Sabe De
- London Health Sciences, Western University, London, Ontario, Canada
| | | | - Stephen Fremes
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Lee Green
- University of Alberta, Edmonton, Alberta, Canada
| | - Haissam Haddad
- University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Karen Harkness
- Hamilton Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | | | - Simon Kouz
- Centre Hospitalier Régional de Lanaudière, Joliette, Québec, Canada
| | | | | | | | - Andre Roussin
- Centre hospitalier de l'Université de Montréal, Montréal, Québec, Canada
| | - Bruce Sussex
- Memorial University, St John's, Newfoundland, Canada
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Belardinelli R, Capestro F, Misiani A, Scipione P, Georgiou D. Moderate exercise training improves functional capacity, quality of life, and endothelium-dependent vasodilation in chronic heart failure patients with implantable cardioverter defibrillators and cardiac resynchronization therapy. ACTA ACUST UNITED AC 2016; 13:818-25. [PMID: 17001224 DOI: 10.1097/01.hjr.0000230104.93771.7d] [Citation(s) in RCA: 106] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The objective of this study was to determine the effects of a moderate exercise training program on functional capacity, quality of life, and hospital readmission rate in chronic heart failure patients with implantable cardioverter defibrillators and cardiac resynchronization therapy. METHODS AND RESULTS We studied 52 men (mean age 55+/-10 years, ejection fraction 31+/-7%) in chronic heart failure II (n=29) and III (n=23) NYHA functional class with ischemic cardiomyopathy who received implantable cardioverter defibrillators with or without cardiac resynchronization therapy. Patients were randomized into two groups. Group T (n=30 patients, 15 implantable cardioverter defibrillator, 15 implantable cardioverter defibrillator+cardiac resynchronization therapy) underwent a supervised exercise training program at 60% of peak VO2 three times a week for 8 weeks. Group C (n=22 patients, 12 implantable cardioverter defibrillator, 10 implantable cardioverter defibrillator+cardiac resynchronization therapy) avoided physical training. At 8 weeks, only trained patients had improvements in peak VO2 (P<0.01 versus C), endothelium-dependent dilatation of the brachial artery (P<0.001 versus C) and quality of life (P<0.001 versus C). Among trained patients, those with cardiac resynchronization therapy had greater improvements in peak VO2 and quality of life. During the follow-up (24+/-6 months), eight controls had sustained ventricular tachycardia requiring hospital readmission, while no trained patients had adverse events (log rank 8.56; P<0.001). The improvement in peak VO2 was correlated with the improvement in endothelium-dependent dilatation (r=0.65). CONCLUSION Moderate exercise training is safe and has beneficial effects after implantable cardioverter defibrillator implantation, especially when cardiac resynchronization therapy is present. These effects are associated with improvement in quality of life and outcome.
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Lau ET, Thompson EA, Burr RL, Dougherty CM. Safety and Efficacy of an Early Home-Based Walking Program After Receipt of an Initial Implantable Cardioverter-Defibrillator. Arch Phys Med Rehabil 2016; 97:1228-36. [DOI: 10.1016/j.apmr.2016.02.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Revised: 02/03/2016] [Accepted: 02/09/2016] [Indexed: 01/06/2023]
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Clinical Effects and Implications of Cardiac Rehabilitation for Implantable Cardioverter Defibrillator Patients: A Mixed-Methods Approach Embedding Data From the Copenhagen Outpatient ProgrammE-Implantable Cardioverter Defibrillator Randomized Clinical Trial With Qualitative Data. J Cardiovasc Nurs 2016; 30:420-7. [PMID: 25055078 DOI: 10.1097/jcn.0000000000000179] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The Copenhagen Outpatient ProgrammE-Implantable Cardioverter Defibrillator trial was a randomized clinical trial that compared a complex rehabilitation intervention including exercise training and psychoeducational interventions with usual care. A significant difference between rehabilitation and usual care was found in physical capacity and general and mental health. However, the clinical effect sizes of these findings were not investigated, and the findings from the quantitative and qualitative analyses were not triangulated to address the issue of whether the qualitative results could help explain the quantitative results and bring forward additional information. OBJECTIVES The objectives are to (a) determine the clinical effect sizes of the primary outcomes and (b) triangulate the quantitative and qualitative findings. METHODS A total of 196 patients with first-time implantable cardioverter defibrillator implantation were randomized (1:1) to comprehensive cardiac rehabilitation (12 weeks of exercise training and 1 year of psychoeducational follow-up) versus treatment as usual. Two primary outcomes, perceived health (Short Form-36) and peak oxygen uptake, were used. Cohen d was calculated. Qualitative interviews were conducted with 10 patients representing the rehabilitation group. Triangulation was carried out by integrating the findings from the quantitative and qualitative results in light of each other. RESULTS Clinically meaningful effects were found between groups in peak oxygen uptake, general health, and mental health in favor of the rehabilitation group. Within groups, we found medium/high effect sizes on the mental component score in the rehabilitation group over time and only a small effect in the usual care group. The mechanisms of these effects were further explained by the qualitative findings. Patients with better physical health learned how to interpret body signals and adjust exercise behavior and experienced increased physical capacity. Those with better mental health received support that assisted them to cope with the possibility of shock and death and regain trust in their bodies. CONCLUSION The program has a clinical effect and is perceived as beneficial through supportive coping.
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Abstract
Physical exercise has been recognized as a standard therapy in the guidelines for secondary prevention of chronic heart failure. In clinical practice its benefits are widely underestimated. It is still too rarely applied as a therapeutic component, despite overwhelming scientific evidence, including meta-analyses illustrating the positive effect on exercise capacity, quality of life and hospitalization. It is crucial that patients undergo a thorough clinical investigation, including exercise testing and are in a clinically stable condition for at least 6 weeks under optimal guideline-conform medicinal therapy before exercise training is initiated. Moreover, it is important that only approved exercise regimens should be prescribed and exercise sessions should be appropriately monitored. Both moderate continuous endurance training and recently developed interval training have been shown to be safe and effective in chronic heart failure. Ideally, endurance training should be combined with moderate resistance training. Current evidence clearly demonstrates a dose-response relationship in the way that beneficial effects of exercise training are strongly related to factors such as exercise duration and intensity. Development of strategies that support long-term adherence to exercise training are a crucial challenge for both daily practice and future research.
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Affiliation(s)
- M Dörr
- Klinik und Poliklinik für Innere Medizin B, AG Kardiovaskuläre Epidemiologie und Prävention, Universitätsmedizin Greifswald, Ferdinand-Sauerbruch-Str., 17475, Greifswald, Deutschland,
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DOUGHERTY CYNTHIAM, LUTTRELL MATILDAN, BURR ROBERTL, KIM MISUN, HASKELL WILLIAML. Adherence to an Aerobic Exercise Intervention after an Implantable Cardioverter Defibrillator (ICD). PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2015; 39:128-39. [DOI: 10.1111/pace.12782] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Revised: 10/26/2015] [Accepted: 10/28/2015] [Indexed: 01/23/2023]
Affiliation(s)
| | | | - ROBERT L. BURR
- School of Nursing; University of Washington; Seattle Washington
| | - MISUN KIM
- School of Nursing; University of Washington; Seattle Washington
| | - WILLIAM L. HASKELL
- Stanford Prevention Research Center, School of Medicine; Stanford University; Palo Alto California
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24
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Nielsen KM, Zwisler AD, Taylor RS, Svendsen JH, Lindschou J, Anderson L, Berg SK. Exercise-based cardiac rehabilitation for adult patients with an implantable cardioverter defibrillator. Hippokratia 2015. [DOI: 10.1002/14651858.cd011828] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- Kim M Nielsen
- Rigshospitalet, Copenhagen University Hospital; Department of Cardiology, The Heart Centre; Blegdamsvej 9 Copenhagen Denmark 2100
| | - Ann-Dorthe Zwisler
- Rigshospitalet, Copenhagen University Hospital; Department of Cardiology, The Heart Centre; Blegdamsvej 9 Copenhagen Denmark 2100
| | - Rod S Taylor
- University of Exeter Medical School; Institute of Health Research; Exeter UK EX2 4SG
| | - Jesper H Svendsen
- Rigshospitalet, Copenhagen University Hospital; Department of Cardiology, The Heart Centre; Blegdamsvej 9 Copenhagen Denmark 2100
| | - Jane Lindschou
- Department 7812, Rigshospitalet, Copenhagen University Hospital; Copenhagen Trial Unit, Centre for Clinical Intervention Research; Blegdamsvej 9 Copenhagen Denmark DK-2100
| | - Lindsey Anderson
- University of Exeter Medical School; Institute of Health Research; Exeter UK EX2 4SG
| | - Selina K Berg
- Rigshospitalet, Copenhagen University Hospital; Department of Cardiology, The Heart Centre; Blegdamsvej 9 Copenhagen Denmark 2100
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Abstract
Athletes with an implantable cardioverter defibrillator (ICD) represent a diverse group of individuals who may be at an increased risk of sudden cardiac death when engaging in vigorous physical activity. Therefore, they are excluded by the current guidelines from participating in most competitive sports except those classified as low intensity, such as bowling and golf. The lack of substantial data on the natural history of the cardiac diseases affecting these athletes as well as the unknown efficacy of ICDs in terminating life-threatening arrhythmias occurring during intense exercise has resulted in the restrictive nature of these now decade old guidelines.
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Affiliation(s)
- Shiva P. Ponamgi
- Hospitalist, Mayo Clinic Health System – Austin, Division of Hospital Internal Medicine, Austin, MN 55912, Phone: 507-433-7351
| | - Christopher V. DeSimone
- Assistant Professor of Medicine, Cardiovascular Fellow, Division of Cardiovascular Medicine, Mayo Clinic, 200 First Street SW, Mary Brigh Building 4-506, Rochester, MN 55905, Phone: 507-266-3089
| | - Michael J. Ackerman
- Professor of Medicine, Pediatrics, and Pharmacology, Mayo Clinic Windland Smith Rice Sudden Death Genomics Laboratory, 200 First Street SW, Guggenheim 5-01, Rochester, MN 55905, 507-284-0101 (phone), 507-284-3757 (fax)
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Voss F, Schueler M, Lauterbach M, Bauer A, Katus HA, Becker R. Safety of symptom-limited exercise testing in a big cohort of a modern ICD population. Clin Res Cardiol 2015; 105:53-8. [PMID: 26123830 DOI: 10.1007/s00392-015-0885-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Accepted: 06/11/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Exercise may predispose to ventricular arrhythmias especially in patients with congestive heart failure. As therapy with implanted cardioverter-defibrillators (ICDs) has become standard medical care, there is an emerging number of exercise tests that need to be performed in patients with ICDs. In contrast, little is known about the safety of symptom-limited exercise testing in these patients. METHODS AND RESULTS 400 ICD patients performed symptom-limited exercise treadmill testing. 200 patients performed a ramp protocol with an initial workload of 0 W increased by 15 W every minute. Another 200 ICD patients did a slightly modified ramp protocol with again an initial workload of 0 W but with an increased capacity of 15 W every 2 min. The study population consists mainly of patients with ischemic (63%) and non-ischemic (34%) heart disease. Atrial fibrillation was present in 16% of the subjects. The mean ejection fraction was 28 ± 8, and 78% of the patients had an ejection fraction below 30%. In this cohort of patients, no sustained ventricular arrhythmias and no deaths occurred during or after exercise testing. No inappropriate shock delivery was observed. The modified ramp protocol resulted in a prolonged exercise time with equal exercise capacity but does not result in an enhanced susceptibility for ventricular arrhythmias. CONCLUSIONS Symptom-limited exercise treadmill testing in heart failure patients with ICDs is a safe procedure. The use of a ramp protocol is sufficient in terms of safety and is easy to perform in general practice. The exercise duration in heart failure patients with ICDs does not predict serious adverse events.
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Affiliation(s)
- Frederik Voss
- Department of Cardiology, Krankenhaus der Barmherzigen Brueder Trier, Nordallee 1, 54290, Trier, Germany.
| | - Melanie Schueler
- Department of Cardiology, University of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - Michael Lauterbach
- Department of Cardiology, Krankenhaus der Barmherzigen Brueder Trier, Nordallee 1, 54290, Trier, Germany
| | - Alexander Bauer
- Department of Cardiology, Diakonie-Klinikum Schwaebisch Hall, Diakoniestr. 10, 74523, Schwaebisch Hall, Germany
| | - Hugo A Katus
- Department of Cardiology, University of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - Ruediger Becker
- Department of Cardiology, University of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
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Asrar Ul Haq M, Goh CY, Levinger I, Wong C, Hare DL. Clinical utility of exercise training in heart failure with reduced and preserved ejection fraction. CLINICAL MEDICINE INSIGHTS-CARDIOLOGY 2015; 9:1-9. [PMID: 25698883 PMCID: PMC4324467 DOI: 10.4137/cmc.s21372] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2014] [Revised: 12/29/2014] [Accepted: 01/04/2015] [Indexed: 12/13/2022]
Abstract
Reduced exercise tolerance is an independent predictor of hospital readmission and mortality in patients with heart failure (HF). Exercise training for HF patients is well established as an adjunct therapy, and there is sufficient evidence to support the favorable role of exercise training programs for HF patients over and above the optimal medical therapy. Some of the documented benefits include improved functional capacity, quality of life (QoL), fatigue, and dyspnea. Major trials to assess exercise training in HF have, however, focused on heart failure with reduced ejection fraction (HFREF). At least half of the patients presenting with HF have heart failure with preserved ejection fraction (HFPEF) and experience similar symptoms of exercise intolerance, dyspnea, and early fatigue, and similar mortality risk and rehospitalization rates. The role of exercise training in the management of HFPEF remains less clear. This article provides a brief overview of pathophysiology of reduced exercise tolerance in HFREF and heart failure with preserved ejection fraction (HFPEF), and summarizes the evidence and mechanisms by which exercise training can improve symptoms and HF. Clinical and practical aspects of exercise training prescription are also discussed.
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Affiliation(s)
- Muhammad Asrar Ul Haq
- Northern Heart, The Northern Hospital, Melbourne, Vic, Australia
- Austin Health, Melbourne, Vic, Australia
- University of Melbourne, Melbourne, Vic, Australia
| | - Cheng Yee Goh
- Northern Heart, The Northern Hospital, Melbourne, Vic, Australia
| | - Itamar Levinger
- Institute of Sport, Exercise and Active Living (ISEAL), College of Sport and Exercise Science, Victoria University, Melbourne, Australia
| | - Chiew Wong
- Northern Heart, The Northern Hospital, Melbourne, Vic, Australia
- University of Melbourne, Melbourne, Vic, Australia
| | - David L Hare
- Austin Health, Melbourne, Vic, Australia
- University of Melbourne, Melbourne, Vic, Australia
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Piccini JP, Hellkamp AS, Whellan DJ, Ellis SJ, Keteyian SJ, Kraus WE, Hernandez AF, Daubert JP, Piña LL, O'Connor CM. Exercise training and implantable cardioverter-defibrillator shocks in patients with heart failure: results from HF-ACTION (Heart Failure and A Controlled Trial Investigating Outcomes of Exercise TraiNing). JACC-HEART FAILURE 2014; 1:142-8. [PMID: 23936756 DOI: 10.1016/j.jchf.2013.01.005] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVES The purpose of this study was to determine whether exercise training is associated with an increased risk of implantable cardioverter-defibrillator (ICD) therapy in patients with heart failure (HF). BACKGROUND Few data are available regarding the safety of exercise training in patients with ICDs and HF. METHODS HF-ACTION (Heart Failure and A Controlled Trial Investigating Outcomes of Exercise TraiNing) randomized 2,331 outpatients with HF and an ejection fraction (EF) ≤35% to exercise training or usual care. Cox proportional hazards modeling was used to examine the relationship between exercise training and ICD shocks. RESULTS We identified 1,053 patients (45%) with an ICD at baseline who were randomized to exercise training (n = 546) or usual care (n = 507). Median age was 61 years old, and median EF was 24%. Over a median of 2.2 years of follow-up, 20% (n = 108) of the exercise patients had a shock versus 22% (n = 113) of the control patients. A history of sustained ventricular tachycardia/fibrillation (hazard ratio [HR]: 1.93 [95% confidence interval (CI): 1.47 to 2.54]), previous atrial fibrillation/flutter (HR: 1.63 [95% CI: 1.22 to 2.18]), exercise-induced dysrhythmia (HR: 1.67 [95% CI: 1.23 to 2.26]), lower diastolic blood pressure (HR for 5-mm Hg decrease <60: 1.35 [95% CI: 1.12 to 1.61]), and nonwhite race (HR: 1.50 [95% CI: 1.13 to 2.00]) were associated with an increased risk of ICD shocks. Exercise training was not associated with the occurrence of ICD shocks (HR: 0.90 [95% CI: 0.69 to 1.18], p = 0.45). The presence of an ICD was not associated with the primary efficacy composite endpoint of death or hospitalization (HR: 0.99 [95% CI: 0.86 to 1.14], p = 0.90). CONCLUSIONS We found no evidence of increased ICD shocks in patients with HF and reduced left ventricular function who underwent exercise training. Exercise therapy should not be prohibited in ICD recipients with HF. (Exercise Training Program to Improve Clinical Outcomes in Individuals With Congestive Heart Failure; NCT00047437)
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Exercise training and pacing status in patients with heart failure: results from HF-ACTION. J Card Fail 2014; 21:60-7. [PMID: 25463413 DOI: 10.1016/j.cardfail.2014.10.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2014] [Revised: 08/25/2014] [Accepted: 10/06/2014] [Indexed: 12/28/2022]
Abstract
BACKGROUND We sought to determine if outcomes with exercise training in heart failure (HF) vary according to ventricular pacing type. METHODS AND RESULTS Heart Failure: A Controlled Trial Investigating Outcomes of Exercise Training (HF-ACTION) randomized 2,331 outpatients with HF and left ventricular ejection fraction ≤35% to usual care plus exercise training or usual care alone. We examined the relationship between outcomes and randomized treatment according to ventricular pacing status with the use of Cox proportional hazards modeling. In HF-ACTION 1,118 patients (48%) had an implanted cardiac rhythm device: 683 with right ventricular (RV) and 435 with biventricular (BiV) pacemakers. Patients with pacing devices were older, more frequently white, and had lower peak VO2 (P < .001 for all). Peak VO2 improved similarly with training in groups with and without pacing devices. The primary composite end point-all-cause death or hospitalization-was reduced only in patients randomized to exercise training without a device (hazard ratio [HR] 0.79, 95% confidence interval [CI] 0.67-0.93 [P = .004]; RV lead: HR 1.04, 95% CI 0.84-1.28 [P = .74]; BiV pacing: HR 1.05, 95% CI 0.82-1.34 [P = .72]; interaction P = .058). CONCLUSIONS Exercise training may improve exercise capacity in patients with implanted cardiac devices. However, the apparent beneficial effects of exercise on hospitalization or death may be attenuated in patients with implanted cardiac devices and requires further study.
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CHRISTENSEN ANNEVINGGAARD, ZWISLER ANNDORTHE, SVENDSEN JESPERHASTRUP, PEDERSEN PREBENULRICH, BLUNK LOUISE, THYGESEN LAUCASPAR, BERG SELINAKIKKENBORG. Effect of Cardiac Rehabilitation in Patients with ICD: Are Gender Differences Present? Results from the COPE-ICD Trial. Pacing Clin Electrophysiol 2014; 38:18-27. [DOI: 10.1111/pace.12507] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
| | - ANN-DORTHE ZWISLER
- The Heart Centre; Rigshospitalet; Copenhagen University Hospital; Copenhagen Denmark
- Department of Cardiology; Holbaek Hospital; Denmark
- The National Institute of Public Health; University of Southern Denmark; Copenhagen Denmark
| | - JESPER HASTRUP SVENDSEN
- The Heart Centre; Rigshospitalet; Copenhagen University Hospital; Copenhagen Denmark
- Danish National Research Foundation Centre for Cardiac Arrhythmia (DARC); University of Copenhagen; Copenhagen Denmark
- Department of Clinical Medicine; Faculty of Health and Medical Sciences; University of Copenhagen; Copenhagen Denmark
| | - PREBEN ULRICH PEDERSEN
- Centre of Clinical Guidelines - Clearinghouse; Faculty of Medicine and Technology; Aalborg University; Aalborg Denmark
| | - LOUISE BLUNK
- The Heart Centre; Rigshospitalet; Copenhagen University Hospital; Copenhagen Denmark
| | - LAU CASPAR THYGESEN
- The National Institute of Public Health; University of Southern Denmark; Copenhagen Denmark
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32
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Berg SK, Pedersen PU, Zwisler AD, Winkel P, Gluud C, Pedersen BD, Svendsen JH. Comprehensive cardiac rehabilitation improves outcome for patients with implantable cardioverter defibrillator. Findings from the COPE-ICD randomised clinical trial. Eur J Cardiovasc Nurs 2014; 14:34-44. [PMID: 24504872 DOI: 10.1177/1474515114521920] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
AIMS The aim of this randomised clinical trial was to assess a comprehensive cardiac rehabilitation intervention including exercise training and psycho-education vs 'treatment as usual' in patients treated with an implantable cardioverter defibrillator (ICD). METHODS In this study 196 patients with first time ICD implantation (mean age 57.2 (standard deviation (SD)=13.2); 79% men) were randomised (1:1) to comprehensive cardiac rehabilitation vs 'treatment as usual'. Altogether 144 participants completed the 12 month follow-up. The intervention consisted of twelve weeks of exercise training and one year of psycho-educational follow-up focusing on modifiable factors associated with poor outcomes. Two primary outcomes, general health score (Short Form-36 (SF-36)) and peak oxygen uptake (VO₂), were used. Post-hoc analyses included SF-36 and ICD therapy history. RESULTS Comprehensive cardiac rehabilitation significantly increased VO2 uptake after exercise training to 23.0 (95% confidence interval (CI) 20.9-22.7) vs 20.8 (95% CI 18.9-22.7) ml/min/kg in the control group (p=0.004 (multiplicity p=0.015)). Comprehensive cardiac rehabilitation significantly increased general health; at three months (mean 62.8 (95% CI 58.1-67.5) vs 64.4 (95% CI: 59.6-69.2)) points; at six months (mean 66.7 (95% CI 61.5-72.0) vs 61.9 (95% CI 56.1-67.7) points); and 12 months (mean 63.5 (95% CI 57.7-69.3) vs 62.1 (95% CI 56.2-68.0)) points (p <0.05). Explorative analyses showed a significant difference between groups in favour of the intervention group. No significant difference was seen in ICD therapy history. CONCLUSION Comprehensive cardiac rehabilitation combining exercise training and a psycho-educational intervention improves VO₂-uptake and general health. Furthermore, mental health seems improved. No significant difference was found in the number of ICD shocks or anti-tachycardia pacing therapy.
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Affiliation(s)
| | - Preben U Pedersen
- Centre of Clinical Guidelines - Clearinghouse, Faculty of Medicine and Technology, Aalborg University, Denmark
| | - Ann-Dorthe Zwisler
- The Heart Centre Unit 2151, Rigshospitalet, Copenhagen University Hospital, Denmark
| | - Per Winkel
- Centre for Clinical Intervention Research Unit 3344, Copenhagen University Hospital, Denmark
| | - Christian Gluud
- Centre for Clinical Intervention Research Unit 3344, Copenhagen University Hospital, Denmark
| | | | - Jesper H Svendsen
- Danish National Research Foundation Centre for Cardiac Arrhythmia (DARC), University of Copenhagen, Denmark
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33
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Isaksen K, Munk PS, Valborgland T, Larsen AI. Aerobic interval training in patients with heart failure and an implantable cardioverter defibrillator: a controlled study evaluating feasibility and effect. Eur J Prev Cardiol 2014; 22:296-303. [DOI: 10.1177/2047487313519345] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Kjetil Isaksen
- Stavanger University Hospital, Stavanger, Norway
- University of Bergen, Bergen, Norway
| | - Peter S Munk
- Stavanger University Hospital, Stavanger, Norway
| | - Torstein Valborgland
- Stavanger University Hospital, Stavanger, Norway
- University of Bergen, Bergen, Norway
| | - Alf I Larsen
- Stavanger University Hospital, Stavanger, Norway
- University of Bergen, Bergen, Norway
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34
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Moe GW, Ezekowitz JA, O'Meara E, Howlett JG, Fremes SE, Al-Hesayen A, Heckman GA, Ducharme A, Estrella-Holder E, Grzeslo A, Harkness K, Lepage S, McDonald M, McKelvie RS, Nigam A, Rajda M, Rao V, Swiggum E, Virani S, Van Le V, Zieroth S, Arnold JMO, Ashton T, D'Astous M, Dorian P, Giannetti N, Haddad H, Isaac DL, Kouz S, Leblanc MH, Liu P, Ross HJ, Sussex B, White M. The 2013 Canadian Cardiovascular Society Heart Failure Management Guidelines Update: focus on rehabilitation and exercise and surgical coronary revascularization. Can J Cardiol 2013; 30:249-63. [PMID: 24480445 DOI: 10.1016/j.cjca.2013.10.010] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2013] [Revised: 10/09/2013] [Accepted: 10/09/2013] [Indexed: 12/25/2022] Open
Abstract
The 2013 Canadian Cardiovascular Society Heart Failure Management Guidelines Update provides focused discussions on the management recommendations on 2 topics: (1) exercise and rehabilitation; and (2) surgical coronary revascularization in patients with heart failure. First, all patients with stable New York Heart Association class I-III symptoms should be considered for enrollment in a tailored exercise training program, to improve exercise tolerance and quality of life. Second, selected patients with suitable coronary anatomy should be considered for bypass graft surgery. As in previous updates, the topics were chosen in response to stakeholder feedback. The 2013 Update also includes recommendations, values and preferences, and practical tips to assist the clinicians and health care workers manage their patients with heart failure.
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Affiliation(s)
- Gordon W Moe
- St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.
| | | | - Eileen O'Meara
- Institut de Cardiologie de Montréal, Montreal, Québec, Canada
| | | | - Steve E Fremes
- Sunnybrook Health Science Centre, Toronto, Ontario, Canada
| | - Abdul Al-Hesayen
- St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | | | - Anique Ducharme
- Institut de Cardiologie de Montréal, Montreal, Québec, Canada
| | | | - Adam Grzeslo
- Joseph Brant Memorial Hospital, Burlington, Ontario, Canada; Hamilton Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Karen Harkness
- Hamilton Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Serge Lepage
- Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Michael McDonald
- University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Robert S McKelvie
- Hamilton Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Anil Nigam
- Institut de Cardiologie de Montréal, Montreal, Québec, Canada
| | - Miroslaw Rajda
- QE II Health Sciences Centre, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Vivek Rao
- University Health Network, University of Toronto, Toronto, Ontario, Canada
| | | | - Sean Virani
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Vy Van Le
- Centre Hospitalier Universitaire de l'Université de Montréal, Québec, Canada
| | - Shelley Zieroth
- Cardiac Sciences Program, St Boniface General Hospital, Winnipeg, Manitoba, Canada
| | | | | | | | - Paul Dorian
- St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | | | | | | | - Simon Kouz
- Centre Hospitalier Régional de Lanaudière, Joliette, and Université Laval, Québec, Canada
| | | | - Peter Liu
- Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Heather J Ross
- University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Bruce Sussex
- Health Sciences Centre, St John's, Newfoundland, Canada
| | - Michel White
- Institut de Cardiologie de Montréal, Montreal, Québec, Canada
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Fletcher GF, Ades PA, Kligfield P, Arena R, Balady GJ, Bittner VA, Coke LA, Fleg JL, Forman DE, Gerber TC, Gulati M, Madan K, Rhodes J, Thompson PD, Williams MA. Exercise standards for testing and training: a scientific statement from the American Heart Association. Circulation 2013; 128:873-934. [PMID: 23877260 DOI: 10.1161/cir.0b013e31829b5b44] [Citation(s) in RCA: 1186] [Impact Index Per Article: 107.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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36
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De Maeyer C, Beckers P, Vrints CJ, Conraads VM. Exercise training in chronic heart failure. Ther Adv Chronic Dis 2013; 4:105-17. [PMID: 23634278 DOI: 10.1177/2040622313480382] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
The syndrome of heart failure (HF) is a growing epidemic that causes a significant socio-economic burden. Despite considerable progress in the management of patients with HF, mortality and morbidity remain a major healthcare concern and frequent hospital admissions jeopardize daily life and social activities. Exercise training is an important adjunct nonpharmacological treatment modality for patients with HF that has proven positive effects on mortality, morbidity, exercise capacity and quality of life. Different training modalities are available to target the problems with which HF patients are faced. It is essential to tailor the prescribed exercise regimen, so that both efficiency and safety are guaranteed. Electrical implanted devices and mechanical support should not exclude patients from exercise training; however, particular precautions and a specialized approach are advised. At least 50% of patients with HF, older than 65 years of age, present with HF with preserved ejection fraction (HFPEF). Although the study populations included in studies evaluating the effect of exercise training in this population are small, the results are promising and seem to support the idea that exercise training is beneficial for HFPEF patients. Both the short- and especially long-term adherence to exercise training remain a major challenge that can only be tackled by a multidisciplinary approach. Efforts should be directed towards closing the gap between recommendations and the actual implementation of training programmes.
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Affiliation(s)
- Catherine De Maeyer
- Department of Cardiology, Antwerp University Hospital, Wilrijkstraat 10, 2650 Edegem, Belgium
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37
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Aerobic exercise intensity assessment and prescription in cardiac rehabilitation: a joint position statement of the European Association for Cardiovascular Prevention and Rehabilitation, the American Association of Cardiovascular and Pulmonary Rehabilitation, and the Canadian Association of Cardiac Rehabilitation. J Cardiopulm Rehabil Prev 2013; 32:327-50. [PMID: 23103476 DOI: 10.1097/hcr.0b013e3182757050] [Citation(s) in RCA: 92] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Aerobic exercise intensity prescription is a key issue in cardiac rehabilitation, being directly linked to both the amount of improvement in exercise capacity and the risk of adverse events during exercise. This joint position statement aims to provide professionals with up-to-date information regarding the identification of different exercise intensity domains, the methods of direct and indirect determination of exercise intensity for both continuous and interval aerobic training, the effects of the use of different exercise protocols on exercise intensity prescription and the indications for recommended exercise training prescription in specific cardiac patients' groups. The importance of functional evaluation through exercise testing prior to starting an aerobic training program is strongly emphasized, and ramp incremental cardiopulmonary exercise test, when available, is proposed as the gold standard for a physiologically comprehensive exercise intensity assessment and prescription. This may allow a shift from a 'range-based' to a 'threshold-based' aerobic exercise intensity prescription, which, combined with thorough clinical evaluation and exercise-related risk assessment, could maximize the benefits obtainable by the use of aerobic exercise training in cardiac rehabilitation.
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38
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Schwarz S, Halle M. [From rest to run--make your heart failure patients exercise for a long life]. MMW Fortschr Med 2013; 155:48-50. [PMID: 23614196 DOI: 10.1007/s15006-013-0225-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Affiliation(s)
- Silja Schwarz
- Präventive und Rehabilitative Sportmedizin, Klinikum rechts der Isar, Technische Universität München.
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39
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Isaksen K, Morken IM, Munk PS, Larsen AI. Exercise training and cardiac rehabilitation in patients with implantable cardioverter defibrillators: a review of current literature focusing on safety, effects of exercise training, and the psychological impact of programme participation. Eur J Prev Cardiol 2012; 19:804-12. [PMID: 22988593 DOI: 10.1177/1741826711414624] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Indications for implantable cardioverter defibrillators (ICDs) have been widened considerably during the last decade due to the well-documented effect in the heart failure population. Exercise training (ET) has a 1A recommendation in heart failure. However, data on safety and efficacy of ET in patients with ICDs is sparse. ICD shocks are associated with reduced quality of life and increased mortality. Whether ET may have a beneficial effect in heart failure patients with an ICD is not well documented. METHODS This review is based on a systematic search in the Pub Med database using the terms 'exercise training', 'implantable cardioverter defibrillator', and 'cardiac rehabilitation'. RESULTS Nine studies were identified, comprising 1889 patients. The average duration of exercise-based cardiac rehabilitation (CR) was 9.6 weeks. Ten ICD therapies (seven shocks) were reported in the 834 patients with ICD during ET. Between exercise sessions and during follow up 182 events were recorded including 166 shocks. Three studies (2 randomized) showed that the control group representing sedentary patients were more prone to ICD discharge than patients undergoing CR/ET. In all studies the ICD patients improved their aerobic fitness following ET. Few studies report data on the effect of ET on anxiety and depression. CONCLUSION Based on the current literature, ET in patients with an ICD seems to be safe and is not associated with increased risk of shocks. ET improves aerobic capacity in ICD patients, while effects on anxiety, depression and quality of life are still under debate.
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Affiliation(s)
- Kjetil Isaksen
- Department of Cardiology, Stavanger University Hospital, PO Box 8100, 4068 Stavanger, Norway.
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Mezzani A, Hamm LF, Jones AM, McBride PE, Moholdt T, Stone JA, Urhausen A, Williams MA. Aerobic exercise intensity assessment and prescription in cardiac rehabilitation: a joint position statement of the European Association for Cardiovascular Prevention and Rehabilitation, the American Association of Cardiovascular and Pulmonary Rehabilitation and the Canadian Association of Cardiac Rehabilitation. Eur J Prev Cardiol 2012; 20:442-67. [PMID: 23104970 DOI: 10.1177/2047487312460484] [Citation(s) in RCA: 279] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Aerobic exercise intensity prescription is a key issue in cardiac rehabilitation, being directly linked to both the amount of improvement in exercise capacity and the risk of adverse events during exercise. This joint position statement aims to provide professionals with up-to-date information regarding the identification of different exercise intensity domains, the methods of direct and indirect determination of exercise intensity for both continuous and interval aerobic training, the effects of the use of different exercise protocols on exercise intensity prescription and the indications for recommended exercise training prescription in specific cardiac patients' groups. The importance of functional evaluation through exercise testing prior to starting an aerobic training program is strongly emphasized, and ramp incremental cardiopulmonary exercise test, when available, is proposed as the gold standard for a physiologically comprehensive exercise intensity assessment and prescription. This may allow a shift from a 'range-based' to a 'threshold-based' aerobic exercise intensity prescription, which, combined with thorough clinical evaluation and exercise-related risk assessment, could maximize the benefits obtainable by the use of aerobic exercise training in cardiac rehabilitation.
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Affiliation(s)
- Alessandro Mezzani
- Salvatore Maugeri Foundation IRCCS, Scientific Institute of Veruno, Exercise Pathophysiology Laboratory, Cardiac Rehabilitation Division, Italy.
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41
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Guiraud T, Nigam A, Gremeaux V, Meyer P, Juneau M, Bosquet L. High-intensity interval training in cardiac rehabilitation. Sports Med 2012; 42:587-605. [PMID: 22694349 DOI: 10.2165/11631910-000000000-00000] [Citation(s) in RCA: 179] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
High-intensity interval training (HIIT) is frequently used in sports training. The effects on cardiorespiratory and muscle systems have led scientists to consider its application in the field of cardiovascular diseases. The objective of this review is to report the effects and interest of HIIT in patients with coronary artery disease (CAD) and heart failure (HF), as well as in persons with high cardiovascular risk. A non-systematic review of the literature in the MEDLINE database using keywords 'exercise', 'high-intensity interval training', 'interval training', 'coronary artery disease', 'coronary heart disease', 'chronic heart failure' and 'metabolic syndrome' was performed. We selected articles concerning basic science research, physiological research, and randomized or non-randomized interventional clinical trials published in English. To summarize, HIIT appears safe and better tolerated by patients than moderate-intensity continuous exercise (MICE). HIIT gives rise to many short- and long-term central and peripheral adaptations in these populations. In stable and selected patients, it induces substantial clinical improvements, superior to those achieved by MICE, including beneficial effects on several important prognostic factors (peak oxygen uptake, ventricular function, endothelial function), as well as improving quality of life. HIIT appears to be a safe and effective alternative for the rehabilitation of patients with CAD and HF. It may also assist in improving adherence to exercise training. Larger randomized interventional studies are now necessary to improve the indications for this therapy in different populations.
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Affiliation(s)
- Thibaut Guiraud
- Montreal Heart Institute, Cardiovascular Prevention Centre-Centre PIC, Universit de Montral, Montral, Qubec, Canada.
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Berg SK, Higgins M, Reilly CM, Langberg JJ, Dunbar SB. Sleep quality and sleepiness in persons with implantable cardioverter defibrillators: outcome from a clinical randomized longitudinal trial. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2012; 35:431-43. [PMID: 22303998 DOI: 10.1111/j.1540-8159.2011.03328.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Patients receiving an implantable cardioverter defibrillator (ICD) report various types and degree of sleep disruptions, but little is known regarding their characteristics, duration, and associated factors. The purposes of this study were: (1) to describe the effect of a psychoeducational intervention on sleep quality and daytime sleepiness, (2) to describe patterns of sleep over time, and (3) to identify predictors of poor sleep in an ICD population. METHODS A randomized longitudinal intervention trial was designed to test the effects of a psychoeducational intervention, which included a sleep education and counseling session in patients receiving their initial ICD. Patients (n=236; 75% men; mean age 58.4 [±11.2] from the PsychoEducationAl Intervention for ICD PatiEnts (PEACE) trial comprised the study population. Variables related to sleep were measured by the Pittsburgh Sleep Quality Inventory (PSQI) and Epworth Sleepiness Scale (ESS). RESULTS No psychoeducational intervention effects on sleep outcomes were observed. However, 67.2% of the patients reported poor sleep quality at baseline, and 56.8% had low sleep quality at 6 months based on PSQI scores>5; one-third (32.6%) were excessively sleepy based on ESS scores≥10 at 6 months. Anxiety, depression, physical function, pain intensity, and pain severity were all highly correlated to each other across time. Female gender was a significant covariate for the PSQI. New York Heart Association (NYHA) class was a significant covariate for sleepiness (Epworth). CONCLUSIONS Low sleep quality and daytime sleepiness are found at time of insertion and over time in patients with ICD. Female gender, higher NYHA class, as well as two latent factors encompassing increased anxiety, depressive symptoms, and decreased physical function and increased pain, were significant predictors of poor sleep quality and sleepiness over time. These data help identify those at higher risk for sleep problems after ICD.
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Vanhees L, Rauch B, Piepoli M, van Buuren F, Takken T, Börjesson M, Bjarnason-Wehrens B, Doherty P, Dugmore D, Halle M. Importance of characteristics and modalities of physical activity and exercise in the management of cardiovascular health in individuals with cardiovascular disease (Part III). Eur J Prev Cardiol 2012; 19:1333-56. [DOI: 10.1177/2047487312437063] [Citation(s) in RCA: 137] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
| | - B Rauch
- Centre for Ambulatory Cardiac and Angiologic Rehabilitation, Ludwigshafen, Germany
| | - M Piepoli
- Guglielmo da Saliceto Hospital, Piacenza, Italy
| | | | - T Takken
- University Medical Center Utrecht, Utrecht, The Netherlands
| | - M Börjesson
- Sahlgrenska University Hospital/Ostra, Goteborg, Sweden
| | | | | | - D Dugmore
- Wellness International Medical Centre, Stockport, UK
| | - M Halle
- University Hospital ‘Klinikum rechts der Isar’, Technische Universitaet Muenchen, Munich, Germany
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Satoh A, Niwano S, Niwano H, Kamiya K, Kishihara J, Aoyama Y, Kameda R, Oikawa J, Yuge M, Izumi T. Prediction of Inappropriate Implantable Cardioverter-Defibrillator Therapies Through Parameters Obtained in a Simple Exercise Stress Test. Int Heart J 2012; 53:276-81. [DOI: 10.1536/ihj.53.276] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Akira Satoh
- Department of Cardio-Angiology, Kitasato University School of Medicine
| | - Shinichi Niwano
- Department of Cardio-Angiology, Kitasato University School of Medicine
| | - Hiroe Niwano
- Department of Education, College of Education, Tamagawa University
| | - Kentaro Kamiya
- Cardiac Rehabilitation Room, Kitasato University Hospital
| | - Jun Kishihara
- Department of Cardio-Angiology, Kitasato University School of Medicine
| | - Yuya Aoyama
- Department of Cardio-Angiology, Kitasato University School of Medicine
| | - Ryo Kameda
- Department of Cardio-Angiology, Kitasato University School of Medicine
| | - Jun Oikawa
- Department of Cardio-Angiology, Kitasato University School of Medicine
| | - Masaru Yuge
- Department of Cardio-Angiology, Kitasato University School of Medicine
| | - Tohru Izumi
- Department of Cardio-Angiology, Kitasato University School of Medicine
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Piepoli MF, Conraads V, Corrà U, Dickstein K, Francis DP, Jaarsma T, McMurray J, Pieske B, Piotrowicz E, Schmid JP, Anker SD, Solal AC, Filippatos GS, Hoes AW, Gielen S, Giannuzzi P, Ponikowski PP. Exercise training in heart failure: from theory to practice. A consensus document of the Heart Failure Association and the European Association for Cardiovascular Prevention and Rehabilitation. Eur J Heart Fail 2011; 13:347-57. [PMID: 21436360 DOI: 10.1093/eurjhf/hfr017] [Citation(s) in RCA: 467] [Impact Index Per Article: 35.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The European Society of Cardiology heart failure guidelines firmly recommend regular physical activity and structured exercise training (ET), but this recommendation is still poorly implemented in daily clinical practice outside specialized centres and in the real world of heart failure clinics. In reality, exercise intolerance can be successfully tackled by applying ET. We need to encourage the mindset that breathlessness may be evidence of signalling between the periphery and central haemodynamic performance and regular physical activity may ultimately bring about favourable changes in myocardial function, symptoms, functional capacity, and increased hospitalization-free life span and probably survival. In this position paper, we provide practical advice for the application of exercise in heart failure and how to overcome traditional barriers, based on the current scientific and clinical knowledge supporting the beneficial effect of this intervention.
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Affiliation(s)
- Massimo F Piepoli
- Heart Failure Unit, Cardiac Department, G Da Saliceto Hospital, I-29100 Piacenza, Italy.
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Berg SK, Svendsen JH, Zwisler AD, Pedersen BD, Preisler P, Siersbæk-Hansen L, Hansen MB, Nielsen RH, Pedersen PU. COPE-ICD: a randomised clinical trial studying the effects and meaning of a comprehensive rehabilitation programme for ICD recipients -design, intervention and population. BMC Cardiovasc Disord 2011; 11:33. [PMID: 21682864 PMCID: PMC3131243 DOI: 10.1186/1471-2261-11-33] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2011] [Accepted: 06/17/2011] [Indexed: 11/15/2022] Open
Abstract
Background Growing evidence exists that living with an ICD can lead to fear and avoidance behaviour including the avoidance of physical activity. It has been suggested that psychological stress can increase the risk of shock and predict death. Small studies have indicated a beneficial effect arising from exercise training and psychological intervention, therefore a large-scale rehabilitation programme was set up. Methods/Design A mixed methods embedded experimental design was chosen to include both quantitative and qualitative measures. A randomised clinical trial is its primary component. 196 patients (power-calculated) were block randomised to either a control group or intervention group at a single centre. The intervention consists of a 1-year psycho-educational component provided by two nurses and a 12-week exercise training component provided by two physiotherapists. Our hypothesis is that the COPE-ICD programme will reduce avoidance behaviour, sexual dysfunction and increase quality of life, increase physical capability, reduce the number of treatment-demanding arrhythmias, reduce mortality and acute re-hospitalisation, reduce sickness leading to absence from work and be cost-effective. A blinded investigator will perform all physical tests and data collection. Discussion Most participants are men (79%) with a mean age of 58 (range 20-85). Most ICD implantations are on primary prophylactic indication (66%). 44% is NYHA II. Mean walk capacity (6MWT) is 417 m. Mean perception of General Health (SF-36) is PCS 42.6 and MCS 47.1. A large-scale ICD rehabilitation trial including psycho-educational intervention and exercise training has been initiated and will report findings starting in 2011. Trial Registration ClinicalTrials.gov: NCT00569478
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Affiliation(s)
- Selina K Berg
- Rigshospitalet, The Heart Center, University of Copenhagen, Copenhagen, Denmark.
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47
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Corrà U, Piepoli MF, Carré F, Heuschmann P, Hoffmann U, Verschuren M, Halcox J, Giannuzzi P, Saner H, Wood D, Piepoli MF, Corrà U, Benzer W, Bjarnason-Wehrens B, Dendale P, Gaita D, McGee H, Mendes M, Niebauer J, Zwisler ADO, Schmid JP. Secondary prevention through cardiac rehabilitation: physical activity counselling and exercise training: key components of the position paper from the Cardiac Rehabilitation Section of the European Association of Cardiovascular Prevention and Rehabilitation. Eur Heart J 2010; 31:1967-74. [PMID: 20643803 DOI: 10.1093/eurheartj/ehq236] [Citation(s) in RCA: 221] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Cardiac patients after an acute event and/or with chronic heart disease deserve special attention to restore their quality of life and to maintain or improve functional capacity. They require counselling to avoid recurrence through a combination of adherence to a medication plan and adoption of a healthy lifestyle. These secondary prevention targets are included in the overall goal of cardiac rehabilitation (CR). Cardiac rehabilitation can be viewed as the clinical application of preventive care by means of a professional multi-disciplinary integrated approach for comprehensive risk reduction and global long-term care of cardiac patients. The CR approach is delivered in tandem with a flexible follow-up strategy and easy access to a specialized team. To promote implementation of cardiac prevention and rehabilitation, the CR Section of the EACPR (European Association of Cardiovascular Prevention and Rehabilitation) has recently completed a Position Paper, entitled 'Secondary prevention through cardiac rehabilitation: A condition-oriented approach'. Components of multidisciplinary CR for seven clinical presentations have been addressed. Components include patient assessment, physical activity counselling, exercise training, diet/nutritional counselling, weight control management, lipid management, blood pressure monitoring, smoking cessation, and psychosocial management. Cardiac rehabilitation services are by definition multi-factorial and comprehensive, with physical activity counselling and exercise training as central components in all rehabilitation and preventive interventions. Many of the risk factor improvements occurring in CR can be mediated through exercise training programmes. This call-for-action paper presents the key components of a CR programme: physical activity counselling and exercise training. It summarizes current evidence-based best practice for the wide range of patient presentations of interest to the general cardiology community.
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Affiliation(s)
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- Heart Failure Unit, Cardiac Department, Guglielmo da Saliceto Polichirurgico Hospital, Piacenza 29100, Italy
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Vijgen J, Botto G, Camm J, Hoijer CJ, Jung W, Le Heuzey JY, Lubinski A, Norekvål TM, Santomauro M, Schalij M, Schmid JP, Vardas P. Consensus Statement: Consensus Statement of the European Heart Rhythm Association: Updated Recommendations for Driving by Patients with Implantable Cardioverter Defibrillators. Eur J Cardiovasc Nurs 2010; 9:3-14. [PMID: 20170847 DOI: 10.1016/j.ejcnurse.2010.01.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Johan Vijgen
- Department of Cardiology, Virga Jesse Ziekenhuis, Hasselt, Belgium
| | - Gianluca Botto
- Department of Cardiology, St. Anna Hospital, Como, Italy
| | - John Camm
- Department of Cardiac and Vascular Sciences, St. George's University, London, United Kingdom
| | | | - Werner Jung
- Department of Cardiology, Academic Hospital Villingen, Villingen-Schwenningen, Germany
| | | | - Andrzej Lubinski
- Department of Interventional Cardiology, Medical University of Lodz, Poland
| | - Tone M. Norekvål
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | | | - Martin Schalij
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Jean-Paul Schmid
- Department of Cardiology, Inselspital, Bern University Hospital and University of Bern, Switzerland
| | - Panos Vardas
- Department of Cardiology, Heraklion University Hospital, Heraklion Crete, Greece
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Morken IM, Severinsson E, Karlsen B. Reconstructing unpredictability: experiences of living with an implantable cardioverter defibrillator over time. J Clin Nurs 2010; 19:537-46. [PMID: 19886873 DOI: 10.1111/j.1365-2702.2009.02898.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Ingvild Margreta Morken
- Faculty of Social Sciences, Department of Health Studies, University of Stavanger, Stavanger, Norway.
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50
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Vijgen J, Botto G, Camm J, Hoijer CJ, Jung W, Le Heuzey JY, Lubinski A, Norekvål TM, Santomauro M, Schalij M, Schmid JP, Vardas P. Consensus statement of the European Heart Rhythm Association: updated recommendations for driving by patients with implantable cardioverter defibrillators. Europace 2009; 11:1097-1107. [PMID: 19525498 DOI: 10.1093/europace/eup112] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/12/2023] Open
Abstract
Patients with an implantable cardioverter defibrillator (ICD) have an ongoing risk of sudden incapacitation that might cause harm to others while driving a car. Driving restrictions vary across different countries in Europe. The most recent recommendations for driving of ICD patients in Europe were published in 1997 and focused mainly on patients implanted for secondary prevention. In recent years there has been a vast increase in the number of patients with an ICD and in the percentage of patients implanted for primary prevention. The EHRA task force on ICD and driving was formed to reassess the risk of driving for ICD patients based on the literature available. The recommendations are summarized in the following table and are further explained in the document. [table: see text] Driving restrictions are perceived as difficult for patients and their families, and have an immediate consequence for their lifestyle. To increase the adherence to the driving restrictions, adequate discharge of education and follow-up of patients and family are pivotal. The task force members hope this document may serve as an instrument for European and national regulatory authorities to formulate uniform driving regulations.
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