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Rouleau CR, Chirico D, Wilton SB, MacDonald MK, Tao T, Arena R, Campbell T, Aggarwal S. Mortality Benefits of Cardiac Rehabilitation in Coronary Artery Disease Are Mediated by Comprehensive Risk Factor Modification: A Retrospective Cohort Study. J Am Heart Assoc 2024; 13:e033568. [PMID: 38761079 DOI: 10.1161/jaha.123.033568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2024] [Accepted: 04/04/2024] [Indexed: 05/20/2024]
Abstract
BACKGROUND Cardiac rehabilitation (CR) is a multicomponent intervention to reduce adverse outcomes from coronary artery disease, but its mechanisms are not fully understood. The aims of this study were to examine the impact of CR on survival and cardiovascular risk factors, and to determine potential mediators between CR attendance and reduced mortality. METHODS AND RESULTS A retrospective mediation analysis was conducted among 11 196 patients referred to a 12-week CR program following an acute coronary syndrome event between 2009 and 2019. A panel of cardiovascular risk factors was assessed at a CR intake visit and repeated on CR completion. All-cause and cardiovascular mortality were ascertained via health care administrative data sets at mean 4.2-year follow-up (SD, 2.81 years). CR completion was associated with reduced all-cause (adjusted hazard ratio [HR], 0.67 [95% CI, 0.54-0.83]) and cardiovascular (adjusted HR, 0.57 [95% CI, 0.40-0.81]) mortality, as well as improved cardiorespiratory fitness, lipid profile, body composition, psychological distress, and smoking rates (P<0.001). CR attendance had an indirect effect on all-cause mortality via improved cardiorespiratory fitness (ab=-0.006 [95% CI, -0.008 to -0.003]) and via low-density lipoprotein cholesterol (ab=-0.002 [95% CI, -0.003 to -0.0003]) and had an indirect effect on cardiovascular mortality via cardiorespiratory fitness (ab=-0.007 [95% CI, -0.012 to -0.003]). CONCLUSIONS Cardiorespiratory fitness and lipid control partly explain the mortality benefits of CR and represent important secondary prevention targets.
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Affiliation(s)
- Codie R Rouleau
- TotalCardiology Research Network Calgary Alberta Canada
- Department of Psychology University of Calgary Calgary Alberta Canada
- Libin Cardiovascular Institute University of Calgary Calgary Alberta Canada
| | | | - Stephen B Wilton
- TotalCardiology Research Network Calgary Alberta Canada
- Libin Cardiovascular Institute University of Calgary Calgary Alberta Canada
| | | | - Tianqi Tao
- Libin Cardiovascular Institute University of Calgary Calgary Alberta Canada
| | - Ross Arena
- TotalCardiology Research Network Calgary Alberta Canada
- Department of Physical Therapy, College of Applied Health Sciences University of Illinois Chicago IL
| | - Tavis Campbell
- TotalCardiology Research Network Calgary Alberta Canada
- Department of Psychology University of Calgary Calgary Alberta Canada
| | - Sandeep Aggarwal
- TotalCardiology Research Network Calgary Alberta Canada
- Libin Cardiovascular Institute University of Calgary Calgary Alberta Canada
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Joaquim A, Góis A, Soares A, Garcia C, Amarelo A, Antunes P, Afreixo V, Geraldes V, Capela A, Viamonte S, Alves AJ, Ferreira HB, Guerra I, Afonso AI, Domingues MR, Helguero LA. Effect of physical exercise on immune, inflammatory, cardiometabolic biomarkers, and fatty acids of breast cancer survivors: results from the MAMA_MOVE Gaia After Treatment trial. Support Care Cancer 2024; 32:174. [PMID: 38378875 DOI: 10.1007/s00520-024-08365-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Accepted: 02/11/2024] [Indexed: 02/22/2024]
Abstract
PURPOSE Physical exercise has positive effects on clinical outcomes of breast cancer survivors such as quality of life, fatigue, anxiety, depression, body mass index, and physical fitness. We aimed to study its impact on immune, inflammatory, cardiometabolic, and fatty acids (FA) biomarkers. METHODS An exploratory sub-analysis of the MAMA_MOVE Gaia After Treatment trial (NCT04024280, registered July 18, 2019) was performed. Blood sample collections occurred during the control phase and at eight weeks of the intervention phase. Samples were subjected to complete leukocyte counts, cytokine, and cardiometabolic marker evaluation using flow cytometry, enzyme-linked immunoassays, and gas chromatography. RESULTS Ninety-three percent of the 15 participants had body mass index ≥ 25 kg/m2. We observed a decrease of the plasmatic saturated FA C20:0 [median difference - 0.08% (p = 0.048); mean difference - 0.1 (95%CI - 0.1, - 0.0)], positively associated with younger ages. A tendency to increase the saturated FA C18:0 and the ratio of unsaturated/saturated FA and a tendency to decrease neutrophils (within the normal range) and interferon-gamma were observed. CONCLUSIONS Positive trends of physical exercise on circulating immune cells, inflammatory cytokines, and plasmatic FA were observed. Larger studies will further elucidate the implications of physical exercise on metabolism. These exploratory findings may contribute to future hypothesis-driven research and contribute to meta-analyses.
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Affiliation(s)
- Ana Joaquim
- Medical Oncology Department, Centro Hospitalar de Vila Nova de Gaia/Espinho (CHVNG/E), 4434-502, Vila Nova de Gaia, Portugal.
- ONCOMOVE®-Associação de Investigação de Cuidados de Suporte em Oncologia (AICSO), 4410-406, Vila Nova de Gaia, Portugal.
- Institute of Biomedicine (IBIMED), Department of Medical Sciences, University of Aveiro, 3810-193, Aveiro, Portugal.
| | - André Góis
- Institute of Biomedicine (IBIMED), Department of Medical Sciences, University of Aveiro, 3810-193, Aveiro, Portugal
| | - Anabela Soares
- Institute of Biomedicine (IBIMED), Department of Medical Sciences, University of Aveiro, 3810-193, Aveiro, Portugal
| | - Catarina Garcia
- ONCOMOVE®-Associação de Investigação de Cuidados de Suporte em Oncologia (AICSO), 4410-406, Vila Nova de Gaia, Portugal
- Research Center in Sports Sciences Health Sciences and Human Development, University of Maia, 4475-690, Maia, Portugal
| | - Anabela Amarelo
- Medical Oncology Department, Centro Hospitalar de Vila Nova de Gaia/Espinho (CHVNG/E), 4434-502, Vila Nova de Gaia, Portugal
- ONCOMOVE®-Associação de Investigação de Cuidados de Suporte em Oncologia (AICSO), 4410-406, Vila Nova de Gaia, Portugal
| | - Pedro Antunes
- ONCOMOVE®-Associação de Investigação de Cuidados de Suporte em Oncologia (AICSO), 4410-406, Vila Nova de Gaia, Portugal
- Research Center in Sports Sciences Health Sciences and Human Development, University of Beira Interior, 6201-001, Covilhã, Portugal
| | - Vera Afreixo
- Department of Mathematics, University of Aveiro, 3810-193, Aveiro, Portugal
- Center for Research & Development in Mathematics and Applications (CIDMA), University of Aveiro, 3810-193, Aveiro, Portugal
| | - Vera Geraldes
- Institute of Physiology, Faculty of Medicine of the University of Lisbon and Cardiovascular Centre of the University of Lisbon, 1649-028, Lisbon, Portugal
| | - Andreia Capela
- Medical Oncology Department, Centro Hospitalar de Vila Nova de Gaia/Espinho (CHVNG/E), 4434-502, Vila Nova de Gaia, Portugal
- ONCOMOVE®-Associação de Investigação de Cuidados de Suporte em Oncologia (AICSO), 4410-406, Vila Nova de Gaia, Portugal
| | - Sofia Viamonte
- ONCOMOVE®-Associação de Investigação de Cuidados de Suporte em Oncologia (AICSO), 4410-406, Vila Nova de Gaia, Portugal
- Institute of Biomedicine (IBIMED), Department of Medical Sciences, University of Aveiro, 3810-193, Aveiro, Portugal
- Centro de Reabilitação Do Norte, Centro Hospitalar de Vila Nova de Gaia/Espinho, 4405-565, Vila Nova de Gaia, Portugal
| | - Alberto J Alves
- ONCOMOVE®-Associação de Investigação de Cuidados de Suporte em Oncologia (AICSO), 4410-406, Vila Nova de Gaia, Portugal
- Research Center in Sports Sciences Health Sciences and Human Development, University of Maia, 4475-690, Maia, Portugal
| | - Helena B Ferreira
- LAQV-REQUIMTE, Department of Chemistry, University of Aveiro, Mass Spectrometry Centre &, 3810-193, Aveiro, Portugal
- Centre for Environmental and Marine Studies (CESAM), Department of Chemistry, University of Aveiro, 3810-193, Aveiro, Portugal
| | - Inês Guerra
- LAQV-REQUIMTE, Department of Chemistry, University of Aveiro, Mass Spectrometry Centre &, 3810-193, Aveiro, Portugal
- Centre for Environmental and Marine Studies (CESAM), Department of Chemistry, University of Aveiro, 3810-193, Aveiro, Portugal
| | - Ana I Afonso
- Institute of Physiology, Faculty of Medicine of the University of Lisbon and Cardiovascular Centre of the University of Lisbon, 1649-028, Lisbon, Portugal
| | - M Rosário Domingues
- LAQV-REQUIMTE, Department of Chemistry, University of Aveiro, Mass Spectrometry Centre &, 3810-193, Aveiro, Portugal
- Centre for Environmental and Marine Studies (CESAM), Department of Chemistry, University of Aveiro, 3810-193, Aveiro, Portugal
| | - Luisa A Helguero
- Institute of Biomedicine (IBIMED), Department of Medical Sciences, University of Aveiro, 3810-193, Aveiro, Portugal
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Viamonte SG, Joaquim AV, Alves AJ, Vilela E, Capela A, Ferreira C, Duarte BF, Rato ND, Teixeira MP, Tavares A, Santos M, Ribeiro F. Cardio-Oncology Rehabilitation for Cancer Survivors With High Cardiovascular Risk: A Randomized Clinical Trial. JAMA Cardiol 2023; 8:1119-1128. [PMID: 37819656 PMCID: PMC10568446 DOI: 10.1001/jamacardio.2023.3558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 08/03/2023] [Indexed: 10/13/2023]
Abstract
Importance Cardiovascular disease is a leading cause of morbidity in cancer survivors, which makes strategies aimed at mitigating cardiovascular risk a subject of major contemporary importance. Objective To assess whether a center-based cardiac rehabilitation (CBCR) framework compared with usual care encompassing community-based exercise training (CBET) is superior for cardiorespiratory fitness improvement and cardiovascular risk factor control among cancer survivors with high cardiovascular risk. Design, Setting, and Participants This prospective, single-center, randomized clinical trial (CORE trial) included adult cancer survivors who had exposure to cardiotoxic cancer treatment and/or previous cardiovascular disease. Enrollment took place from March 1, 2021, to March 31, 2022. End points were assessed at baseline and after the 8-week intervention. Interventions Participants were randomly assigned in a 1:1 ratio to 8 weeks of CBCR or CBET. The combined aerobic and resistance exercise sessions were performed twice a week. Main Outcomes and Measures The powered primary efficacy measure was change in peak oxygen consumption (V̇o2) at 2 months. Secondary outcomes included handgrip maximal strength, functional performance, blood pressure (BP), body composition, body mass index (BMI; calculated as weight in kilograms divided by height in meters squared), lipid profile, plasma biomarker levels, physical activity (PA) levels, psychological distress, quality of life (QOL), and health literacy. Results A total of 75 participants completed the study (mean [SD] age, 53.6 [12.3] years; 58 [77.3%] female), with 38 in the CBCR group and 37 in the CBET group. Participants in CBCR achieved a greater mean (SD) increase in peak V̇o2 than those in CBET (2.1 [2.8] mL/kg/min vs 0.8 [2.5] mL/kg/min), with a between-group mean difference of 1.3 mL/kg/min (95% CI, 0.1-2.6 mL/kg/min; P = .03). Compared with the CBET group, the CBCR group also attained a greater mean (SD) reduction in systolic BP (-12.3 [11.8] mm Hg vs -1.9 [12.9] mm Hg; P < .001), diastolic BP (-5.0 [5.7] mm Hg vs -0.5 [7.0] mm Hg; P = .003), and BMI (-1.2 [0.9] vs 0.2 [0.7]; P < .001) and greater mean (SD) improvements in PA levels (1035.2 [735.7] metabolic equivalents [METs]/min/wk vs 34.1 [424.4] METs/min/wk; P < .001), QOL (14.0 [10.0] points vs 0.4 [12.9] points; P < .001), and health literacy scores (2.7 [1.6] points vs 0.1 [1.4] points; P < .001). Exercise adherence was significantly higher in the CBCR group than in the CBET group (mean [SD] sessions completed, 90.3% [11.8%] vs 68.4% [22.1%]; P < .001). Conclusion and Relevance The CORE trial showed that a cardio-oncology rehabilitation model among cancer survivors with high cardiovascular risk was associated with greater improvements in peak V̇o2 compared with usual care encompassing an exercise intervention in a community setting. The CBCR also showed superior results in exercise adherence, cardiovascular risk factor control, QOL, and health literacy. Trial Registration ClinicalTrials.gov Identifier: NCT05132998.
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Affiliation(s)
- Sofia Gonçalves Viamonte
- North Rehabilitation Center, Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
- ONCOMOVE–Associação de Investigação de Cuidados de Suporte em Oncologia, Vila Nova de Gaia, Portugal
| | - Ana Vieira Joaquim
- ONCOMOVE–Associação de Investigação de Cuidados de Suporte em Oncologia, Vila Nova de Gaia, Portugal
- Oncology Department, Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - Alberto Jorge Alves
- ONCOMOVE–Associação de Investigação de Cuidados de Suporte em Oncologia, Vila Nova de Gaia, Portugal
- University of Maia, Research Center in Sports Sciences, Health Sciences and Human Development, Maia, Portugal
| | - Eduardo Vilela
- ONCOMOVE–Associação de Investigação de Cuidados de Suporte em Oncologia, Vila Nova de Gaia, Portugal
- Cardiology Department, Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - Andreia Capela
- ONCOMOVE–Associação de Investigação de Cuidados de Suporte em Oncologia, Vila Nova de Gaia, Portugal
- Oncology Department, Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - Cristina Ferreira
- Hematology Department, Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - Barbara Fresco Duarte
- ONCOMOVE–Associação de Investigação de Cuidados de Suporte em Oncologia, Vila Nova de Gaia, Portugal
| | - Nuno Dias Rato
- ONCOMOVE–Associação de Investigação de Cuidados de Suporte em Oncologia, Vila Nova de Gaia, Portugal
- University of Maia, Research Center in Sports Sciences, Health Sciences and Human Development, Maia, Portugal
| | | | - Aida Tavares
- ISEG, Lisbon School of Economics and Management, University of Lisbon, Lisbon, Portugal
| | - Mário Santos
- Cardiology Department, Centro Hospitalar Universitário de Santo António, Porto, Portugal
- Unit for Multidisciplinary Investigation in Biomedicine, School of Medicine and Biomedical Sciences Abel Salazar, University of Porto, Porto, Portugal
| | - Fernando Ribeiro
- Institute of Biomedicine, School of Health Sciences, University of Aveiro, Aveiro, Portugal
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Yang Z, Jia H, Wang A. Predictors of home-based cardiac rehabilitation exercise adherence among patients with chronic heart failure: a theory-driven cross-sectional study. BMC Nurs 2023; 22:415. [PMID: 37926820 PMCID: PMC10626687 DOI: 10.1186/s12912-023-01566-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 10/19/2023] [Indexed: 11/07/2023] Open
Abstract
BACKGROUND The factors influencing home-based cardiac rehabilitation exercise adherence among patients with chronic heart failure remain unclear. This study aimed to explore predictors of home-based cardiac rehabilitation exercise adherence in these patients, based on the theory of planned behavior. METHODS This theory-driven, cross-sectional study used convenience sampling to recruit patients with chronic heart failure undergoing home-based cardiac rehabilitation. Instruments used included the Home-Based Cardiac Rehabilitation Exercise Adherence Scale, the Multidimensional Self-Efficacy for Exercise Scale, the Perceived Social Support Scale, and the Tampa Scale for Kinesiophobia Heart. Multivariate linear hierarchical regression analysis was employed to examine the factors influencing exercise adherence. RESULTS A total of 215 patients with chronic heart failure undergoing home-based cardiac rehabilitation participated in the study. The overall score for home cardiac rehabilitation exercise adherence was (48.73 ± 3.92). Multivariate linear hierarchical regression analysis revealed that age (β=-0.087, p = 0.012), education level (β = 0.080, p = 0.020), fear of movement (β=-0.254, p < 0.001), perceived social support (β = 0.451, p < 0.001), and exercise self-efficacy (β = 0.289, p < 0.001) influenced home-based cardiac rehabilitation exercise adherence. In the second model, fear of exercise explained 23.60% of the total variance, while perceived social support and exercise self-efficacy explained 26.60% of the total variance in the third model. CONCLUSION This study found that home-based cardiac rehabilitation exercise adherence in patients with chronic heart failure was suboptimal, and identified its influencing factors. Targeted interventions addressing these factors, such as tailored education, support, and addressing fear of exercise, may help improve exercise adherence.
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Affiliation(s)
- Zhen Yang
- The First Affiliated Hospital of China Medical University, Shenyang, Liaoning, China
| | - Honghong Jia
- Department of Nursing, Harbin Medical University, Harbin, Heilongjiang, China
| | - Aiping Wang
- The First Affiliated Hospital of China Medical University, Shenyang, Liaoning, China.
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Bisceglia I, Canale ML, Silvestris N, Gallucci G, Camerini A, Inno A, Camilli M, Turazza FM, Russo G, Paccone A, Mistrulli R, De Luca L, Di Fusco SA, Tarantini L, Lucà F, Oliva S, Moreo A, Maurea N, Quagliariello V, Ricciardi GR, Lestuzzi C, Fiscella D, Parrini I, Racanelli V, Russo A, Incorvaia L, Calabrò F, Curigliano G, Cinieri S, Gulizia MM, Gabrielli D, Oliva F, Colivicchi F. Cancer survivorship at heart: a multidisciplinary cardio-oncology roadmap for healthcare professionals. Front Cardiovasc Med 2023; 10:1223660. [PMID: 37786510 PMCID: PMC10541962 DOI: 10.3389/fcvm.2023.1223660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 08/24/2023] [Indexed: 10/04/2023] Open
Abstract
In cancer, a patient is considered a survivor from the time of initial diagnosis until the end of life. With improvements in early diagnosis and treatment, the number of cancer survivors (CS) has grown considerably and includes: (1) Patients cured and free from cancer who may be at risk of late-onset cancer therapy-related cardiovascular toxicity (CTR-CVT); (2) Patients with long-term control of not-curable cancers in whom CTR-CVT may need to be addressed. This paper highlights the importance of the cancer care continuum, of a patient-centered approach and of a prevention-oriented policy. The ultimate goal is a personalized care of CS, achievable only through a multidisciplinary-guided survivorship care plan, one that replaces the fragmented management of current healthcare systems. Collaboration between oncologists and cardiologists is the pillar of a framework in which primary care providers and other specialists must be engaged and in which familial, social and environmental factors are also taken into account.
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Affiliation(s)
- Irma Bisceglia
- Integrated Cardiology Services, Cardio-Thoracic-Vascular Department, Azienda Ospedaliera San Camillo Forlanini, Rome, Italy
| | - Maria Laura Canale
- Division of Cardiology, Ospedale Versilia, Azienda Usl Toscana Nord Ovest, Lido di Camaiore, Italy
| | - Nicola Silvestris
- Unit of Medical Oncology, Department of Human Pathology in Adulthood and Childhood Gaetano Barresi, University of Messina, Messina, Italy
| | - Giuseppina Gallucci
- Cardio-oncology Unit, Department of OncoHaematology, IRCCS Referral Cancer Center of Basilicata, Rionero in Vulture (PZ), Italy
| | - Andrea Camerini
- Department of Medical Oncology, Ospedale Versilia, Azienda Usl Toscana Nord Ovest, Lido di Camaiore, Italy
| | - Alessandro Inno
- Department of Oncology, Sacro Cuore Don Calabria Hospital (IRCCS), Negrar, Italy
| | - Massimiliano Camilli
- Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart and Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Fabio Maria Turazza
- Cardiology Department, National Cancer Institute Foundation (IRCCS), Milan, Italy
| | - Giulia Russo
- SC Patologie Cardiovascolari, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), Trieste, Italy
| | - Andrea Paccone
- Department of Cardiology, G. Pascale National Cancer Institute Foundation (IRCCS), Naples, Italy
| | - Raffaella Mistrulli
- Cardiology Unit, Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Lazio, Italy
| | - Leonardo De Luca
- Division of Cardiology, San Camillo-Forlanini Hospital, Rome, Italy
| | | | - Luigi Tarantini
- Divisione di Cardiologia, Arcispedale S. Maria Nuova, Azienda Unità Sanitaria Locale-IRCCS di Reggio-Emilia, Reggio Emilia, Italy
| | - Fabiana Lucà
- Cardiologia Interventistica, Utic, Grande Ospedale Metropolitano, Azienda Ospedaliera Bianchi Melacrino Morelli, Reggio Calabria, Italy
| | - Stefano Oliva
- UOSD Cardiologia di Interesse Oncologico, IRCCS Istituto Tumori "Giovanni Paolo II", Bari, Italy
| | - Antonella Moreo
- Cardio Center De Gasperis, Azienda Socio Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Nicola Maurea
- Department of Cardiology, G. Pascale National Cancer Institute Foundation (IRCCS), Naples, Italy
| | - Vincenzo Quagliariello
- Department of Cardiology, G. Pascale National Cancer Institute Foundation (IRCCS), Naples, Italy
| | | | | | - Damiana Fiscella
- U.O.C. Cardiologia, Ospedale Garibaldi-Nesima, Azienda di Rilievo Nazionale e Alta Specializzazione “Garibaldi”, Catania, Italy
| | - Iris Parrini
- Department of Cardiology, Hospital Mauritian Turin, Turin, Italy
| | - Vito Racanelli
- Department of Interdisciplinary Medicine, School of Medicine, University of Bari Aldo Moro, Bari, Italy
| | - Antonio Russo
- Department of Surgical, Oncological and Oral Sciences, Section of Medical Oncology, Palermo University Hospital, Palermo, Italy
| | - Lorena Incorvaia
- Department of Surgical, Oncological and Oral Sciences, Section of Medical Oncology, Palermo University Hospital, Palermo, Italy
| | - Fabio Calabrò
- Department of Oncology and Specialized Medicine, San Camillo-Forlanini Hospital, Rome, Italy
| | - Giuseppe Curigliano
- Department of Oncology and Hemato-Oncology, University of Milan; Division of Early Drug Development, Istituto Europeo di Oncologia, IRCCS, Milan, Italy
| | - Saverio Cinieri
- Medical Oncology Division and Breast Unit, Senatore Antonio Perrino Hospital, ASL Brindisi, Brindisi, Italy
| | - Michele Massimo Gulizia
- U.O.C. Cardiologia, Ospedale Garibaldi-Nesima, Azienda di Rilievo Nazionale e Alta Specializzazione “Garibaldi”, Catania, Italy
| | - Domenico Gabrielli
- Division of Cardiology, San Camillo-Forlanini Hospital, Rome, Italy
- Fondazione per il Tuo cuore- Heart Care Foundation, Firenze, Italy
| | - Fabrizio Oliva
- Cardiologia 1- Emodinamica, Dipartimento Cardiotoracovascolare “A. De Gasperis”, Azienda Socio Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Furio Colivicchi
- Clinical and Rehabilitation Cardiology Unit, San Filippo Neri Hospital, ASL Roma 1, Rome, Italy
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Hill L, Delgado B, Lambrinou E, Mannion T, Harbinson M, McCune C. Risk and Management of Patients with Cancer and Heart Disease. Cardiol Ther 2023; 12:227-241. [PMID: 36757637 PMCID: PMC10209380 DOI: 10.1007/s40119-023-00305-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 01/13/2023] [Indexed: 02/10/2023] Open
Abstract
Cancer and cardiovascular disease are two of the leading causes of global mortality and morbidity. Medical research has generated powerful lifesaving treatments for patients with cancer; however, such treatments may sometimes be at the expense of the patient's myocardium, leading to heart failure. Anti-cancer drugs, including anthracyclines, can result in deleterious cardiac effects, significantly impacting patients' functional capacity, mental well-being, and quality of life. Recognizing this, recent international guidelines and expert papers published recommendations on risk stratification and care delivery, including that of cardio-oncology services. This review will summarize key evidence with a focus on anthracycline therapy, providing clinical guidance for the non-oncology professional caring for a patient with cancer and heart failure.
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Affiliation(s)
- Loreena Hill
- School of Nursing and Midwifery, Queen's University, 97 Lisburn Road, Belfast, BT9 7BL, UK.
- College of Nursing and Midwifery, Mohammed Bin Rashid University, Dubai, United Arab Emirates.
| | - Bruno Delgado
- Cardiology Department, University Hospital Centre of Oporto, Stº António Hospital, Oporto, Portugal
- Institute of Health Sciences, Portuguese Catholic University, Oporto, Portugal
| | | | - Tara Mannion
- Beaumont Hospital, Dublin, Ireland
- School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
| | - Mark Harbinson
- Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - Claire McCune
- School of Medicine Dentistry and Biomedical Sciences, Queen's University, Belfast, UK
- Belfast Health and Social Care Trust, Belfast, UK
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Viamonte SG, Joaquim AV, Alves A, Vilela E, Capela A, Ferreira C, Duarte B, Rato ND, Tavares AI, Santos M, Ribeiro F. Impact of a COmprehensive cardiac REhabilitation framework among high cardiovascular risk cancer survivors: Protocol for the CORE trial. Int J Cardiol 2023; 371:384-90. [PMID: 36216089 DOI: 10.1016/j.ijcard.2022.09.075] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 08/30/2022] [Accepted: 09/29/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND Cancer survivors are challenging patients, as they often present increased cardiovascular risk. In this background, cardio-oncology rehabilitation frameworks for specific cancer patients have been proposed. However, optimal program designs, as well as their overall safety and efficacy in different subsets of patients, are not fully ascertained. DESIGN Single-center, pragmatic, prospective, randomized controlled trial performed in Portugal aiming to evaluate the impact of a center-based cardiac rehabilitation program, consisting of exercise training, nutritional counselling, psychosocial management and lifestyle behavior change, compared to community-based exercise training, in cancer survivors. METHODS Adult cancer survivors (N = 80) exposed to cardiotoxic cancer treatment and/or with previous cardiovascular disease will be randomized (1:1) to receive either an eight-week cardiac rehabilitation program or community-based exercise training. Primary endpoint is cardiorespiratory fitness; secondary endpoints are physical activity, psychosocial parameters, blood pressure, body composition, lipids and inflammatory parameters. Physical function, quality of life, fatigue, health literacy, and feasibility will be assessed; a cost-effectiveness evaluation will also be performed. Between-group differences at baseline and in the change from baseline to the end of the study will be tested with unpaired t-tests or Mann-Whitney U test. Paired t-tests or Wilcoxon signed-rank test will be performed for within-group comparisons. CONCLUSION This trial will address the overall impact of a contemporary cardiac rehabilitation program framework in cancer survivors, as compared to a community-based exercise training. Given the higher cardiovascular risk in several groups of cancer patients, our results could provide novel insights into optimized preventive strategies in this complex patient population.
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Chen Z, Li M, Yin C, Fang Y, Zhu Y, Feng J. Effects of cardiac rehabilitation on elderly patients with Chronic heart failure: A meta-analysis and systematic review. PLoS One 2022; 17:e0273251. [PMID: 36006944 PMCID: PMC9409506 DOI: 10.1371/journal.pone.0273251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 08/04/2022] [Indexed: 11/22/2022] Open
Abstract
Aims The purpose of this study was to investigate the effects of cardiac rehabilitation (CR) on elderly patients with Chronic heart failure (CHF) by literature search and meta-analysis. Methods We conducted an electronic search on PubMed, Cochrane Library, Embase, CNKI, Wanfang, and VIP database platforms. The search period was from the establishment of the database to November 2021 for randomized controlled studies (RCTs) related to the effects of CR on elderly patients with CHF. The RevMan 5.4 was used for meta-analysis. Results This study included 16 articles involving a total of 1782 patients, including 892 in the CR group and 890 in the control group. Meta-analysis showed that compared with conventional interventions, CR increased left ventricular ejection fraction in elderly patients with CHF [mean difference (MD):5.73,95% confidence interval (CI):2.05 to 9.40,Z = 3.05,P = 0.002], and decreased left ventricular end-diastolic diameter in elderly patients with CHF (MD:-4.82,95%CI:-7.49 to 15,Z = 3.54,P = 0.0004), increased the 6-minute walk test distance (MD:62.66,95% CI:44.40 to 80.92,Z = 6.72,P<0.00001), decreased the rehospitalization rate (OR:0.32,95%) CI: 0.21 0.49, Z = 5.33, P < 0.000001). Conclusions CR can improve cardiac function, prognosis and reduce rehospitalization rate of elderly patients with CHF.
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Affiliation(s)
- Zhuang Chen
- Department of Cardiovascular Medicine, The Fifth People’s Hospital of Jinan, Jinan, Shandong, China
| | - Ming Li
- Department of Cardiovascular Medicine, The Fifth People’s Hospital of Jinan, Jinan, Shandong, China
| | - Chenghua Yin
- Department of Cardiovascular Medicine, The Fifth People’s Hospital of Jinan, Jinan, Shandong, China
| | - Youbo Fang
- Department of Emergency, Yidu Central Hospital, Weifang, Shandong, China
| | - Ye Zhu
- Department of Cardiovascular Medicine, The Fifth People’s Hospital of Jinan, Jinan, Shandong, China
| | - Jing Feng
- Department of Cardiovascular Medicine, The Fifth People’s Hospital of Jinan, Jinan, Shandong, China
- * E-mail:
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Laukkanen JA, Kunutsor SK. Cardiac rehabilitation improves prognosis among patients with co-existing cancer and cardiovascular diseases. Int J Cardiol 2021; 345:109-110. [PMID: 34710492 DOI: 10.1016/j.ijcard.2021.10.143] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 10/22/2021] [Indexed: 11/27/2022]
Affiliation(s)
- Jari A Laukkanen
- Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland; Central Finland Health Care District, Department of Internal Medicine, Jyväskylä, Finland.
| | - Setor K Kunutsor
- National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust and University of Bristol, Bristol, UK; Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Learning & Research Building (Level 1), Southmead Hospital, Bristol, UK
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