Exercise-based cardiac rehabilitation for coronary heart disease: a meta-analysis

Potential role of large language models and personalized medicine to innovate cardiac rehabilitation

Cardiac rehabilitation is a crucial multidisciplinary approach to improve patient outcomes. There is a growing body of evidence that suggests that these programs contribute towards reducing cardiovascular mortality and recurrence. Despite this, cardiac rehabilitation is underutilized and adherence to these programs has been a demonstrated barrier in achieving these outcomes. As a result, there is a growing focus on innovating these programs, especially from the standpoint of digital health and personalized medicine. This editorial discusses the possible roles of large language models, such as their role in ChatGPT, in further personalizing cardiac rehabilitation programs through simplifying medical jargon and employing motivational interviewing techniques, thus boosting patient engagement and adherence. However, these possibilities must be further investigated in the clinical literature. Likewise, the integration of large language models in cardiac rehabilitation will be challenging in its nascent stages to ensure accurate and ethical information delivery.

Impact of Home-Based Cardiac Rehabilitation on Physical Function, Outcomes, and Costs

PURPOSE

Cardiac rehabilitation (CR) improves health outcomes in patients with cardiovascular disease (CVD), but referral, participation, and completion rates are low. Home-based CR (HBCR) is a proposed solution, but studies on its efficacy are limited. We report our experience from a Veterans Affairs HBCR program on physical function, costs, and outcomes overlapping with the coronavirus disease-2019 (COVID-19) pandemic.

METHODS

A 12-week HBCR program included case-managed individualized exercise and risk management. Six functional tests were conducted remotely, safety was monitored, and quality of life and costs were quantified. A composite outcome (death, myocardial infarction, stroke, and cardiac-related hospitalization) was compared between 70 HBCR participants, 131 patients referred to Community Care, and 71 patients undergoing usual care (no CR) over a mean follow-up of 2.5 ± 0.90 years.

RESULTS

Among HBCR participants, there were significant improvements in right and left leg balance (145 and 56%, respectively, P < .001), 30-second chair stand (47%, P < .001), 2-minute step performance (41%, P < .001), right and left 30-second arm curl (31 and 30%, respectively, P < .001), 50-foot walk test (20%, P = .002), 8-foot up and go test (28%, P < .001), and steps/day (82%, P < .001). Composite events were lower among patients in the HBCR group versus those referred to Community Care ( P = .002). Health care costs were significantly lower among patients in the HBCR group compared to those in Community Care ($2101 vs $3289/subject, P < .001).

CONCLUSIONS

A HBCR program that included a broad spectrum of patients with CVD and multiple co-morbidities, performed largely during the COVID-19 pandemic, resulted in significant functional and outcome benefits and reduced costs.

Affective exercise experiences predict physical activity behaviour in cardiac outpatients within a home-based cardiac rehabilitation programme

Home-based cardiac rehabilitation (HBCR) programmes increase exercise capacity but often face poor adherence to physical activity (PA). This study tested the structural validity of the Affective Exercise Experiences Questionnaire (AFFEXX) in a cardiac population and examined the role of the novel construct of affective exercise experiences in predicting exercise behaviour during an HBCR programme. A sample of 177 patients enrolled in a 10-month HBCR programme, completed a moderate-intensity treadmill walking test, and completed the AFFEXX questionnaire and the 7-day Physical Activity Recall at the beginning and end of the programme. Structural equation modelling confirmed the structural validity of the AFFEXX, with a good fit to the data (Comparative Fit Index = 0.97, Tucker-Lewis Index = 0.95, RMSEA = 0.08). Core affective exercise experiences, which were influenced by antecedent appraisals, significantly predicted attraction-antipathy towards exercise. Multiple regression analysis indicated that follow-up PA was significantly predicted by attraction-antipathy towards exercise (b = 0.24, p = 0.001) and baseline PA (b = 0.29, p = 0.001). The model accounted for 31% of the variance in PA. The study highlights the association between attraction towards exercise and adherence to PA in participants enrolled in an HBCR programme, emphasising the importance of this novel construct.

Aerobic, Resistance, and Isometric Exercise to Reduce Blood Pressure Variability: A Network Meta-Analysis of 15 Clinical Trials

Elevated blood pressure variability (BPV) is an emerging independent risk factor for increased cardiovascular diseases (CVD). Many studies are exploring the impacts of regular physical exercise on reducing BPV. This study aimed to investigate whether exercise can be an intervention to control for the short-term and long-term BPV. A literature search was conducted on MEDLINE, Embase, and PsycINFO on February 10, 2025. The clinical trials and other observational studies that investigated the effects of exercise on systolic and diastolic BPV were included. There were no limitations on age, blood pressure (BP) category, or the use of antihypertensive medication. Mean differences and standard deviations (SDs) of the BPV measurements were extracted to derive standardized mean differences (SMD) with a 95% confidence interval (CI). The heterogeneity was assessed by I2, and random-effect models were performed. Our search identified 8359 studies, of which 25 studies reported BPV outcomes. Fifteen clinical trials compared the short-term BPV among participants with or without exercise. Exercise interventions can significantly reduce both systolic BPV (SMD [95% CI] = -0.37[-0.61 to -0.12]) and diastolic BPV (-0.48 [-0.72 to -0.23]). The benefits are stronger for those with hypertension. Different types of exercise were compared in the network meta-analyses, and aerobic exercise showed more benefits than other types of exercise to improve BPV, especially on the diastolic BPV when it was compared with no exercise (-2.52 [-4.05 to -0.99]). No evidence was observed for the long-term BPV. Exercise interventions effectively reduce the variability of both systolic and diastolic blood pressure (DBP). Aerobic exercise is shown to be more effective in reducing diastolic BPV versus no exercise.

Associations Among Perceived Social Support, Physical Activity, and Health-Related Quality of Life in Patients With Ischemic Heart Disease Reporting Moderate to Severe Hopelessness

BACKGROUND

Associations among perceived social support (PSS), physical activity (PA), and health-related quality of life (HRQoL) in individuals with ischemic heart disease (IHD) are well established. However, little is known about these associationsin patients with IHD experiencing hopelessness.

OBJECTIVE

The objective of this study is to explore the associations among PSS, PA, and HRQoL in patients with IHD reporting moderate to severe hopelessness.

METHODS

Using a cross-sectional design, secondary data were collected from 156 participants enrolled in a randomized controlled trial while hospitalized in the Midwestern United States. Data were collected 2 weeks after hospital discharge, including the Cardiac Rehabilitation Exercise Participation Tool, ENRICHD Social Support Inventory, EuroQol 5-Dimension 5-Level, and a demographic form. Linear models were used to assess associations among the variables, and Macro process mediation was completed to explore potential mediation.

RESULTS

Most participants were male, had some college education or higher, and non-Hispanic White. Over half of the sample were married and not employed (eg, disabled, retired). Higher PSS and higher PA were each separately associated with higher HRQoL after adjusting for relevant covariates (PSS: rpartial = -0.24, P = .005; PA: rpartial = -0.23, P = .003). Engagement in PA (rpartial = -0.19, 95% bootstrap CI, -0.34 to -0.03; P = .02) partially mediated the relationship between PSS and HRQoL (rpartial = -0.18, 95% bootstrap CI, -0.35 to -0.01; P = .03) showing a 22% partial mediation with indirect effect at -0.05 (95% CI bootstrap, -0.11 to -0.002).

CONCLUSION

Even among patients with high perceptions of hopelessness, better perceived social support and more engagement in physical activity are associated with better HRQoL. Longitudinal research in larger and more diverse samples is needed to examine the relationships among PSS, PA, and HRQoL in patients with IHD reporting hopelessness.

Mediating effect of self-efficacy on self-perceived burden and kinesiophobia in patients with coronary heart disease after percutaneous coronary intervention in China: a cross-sectional study

OBJECTIVES

To analyse the current state of kinesiophobia, self-perceived burden and self-efficacy in patients with coronary heart disease (CHD) following percutaneous coronary intervention (PCI). In addition, to study the mediating effect of self-efficacy between self-perceived burden and kinesiophobia.

DESIGN

Cross-sectional study.

SETTING

A tertiary-level hospital in Anhui Province, China.

PARTICIPANTS

We recruited a total of 255 patients for this study. The eligible subjects were patients diagnosed with coronary artery disease who underwent successful transradial PCI. The exclusion criteria included patients who had both diseases affecting their exercise ability and severe psychiatric disorders.

PRIMARY AND SECONDARY OUTCOME MEASURES

We used questionnaires consisting of the Self-Efficacy Scale for Chronic Disease (SESC), the Tampa Scale for Kinesiophobia Heart (TSK-SV Heart), the Self-Perceived Burden Scale (SBPS) and a general information data sheet to obtain participant information. SPSS Bootstrap was used for mediated effects analysis.

RESULTS

The total patient score for kinesiophobia, self-perceived burden and self-efficacy was 42.96±5.00, 24.36±7.84 and 7.61±1.46, respectively. Kinesiophobia was negatively and positively associated with self-efficacy (r=-0.368, p<0.01) and self-perceived burden (r=0.271, p<0.01), respectively. The mediating effect of self-efficacy between self-perceived burden and kinesiophobia in patients was 0.046 (95% CI 0.018 to 0.081), accounting for 26.59% of the total effect.

CONCLUSION

Self-efficacy partially mediates self-perceived burden and kinesiophobia in patients. The medical staff of facilities should strengthen the evaluation and monitoring of patients' self-efficacy and self-perceived burden and conduct intervention measures to reduce their kinesiophobia.

Effectiveness of the innovative Austrian phase III cardiac rehabilitation model on cardiovascular risk factors: a nationwide registry

INTRODUCTION

The Austrian model of outpatient cardiac rehabilitation (CR) begins right after discharge from the acute care hospital. During phase II (OUT-II), it provides a facility-based, professionally supervised, multidisciplinary programme of 6 weeks. The subsequent, supervised phase III (OUT-III) lasts 6 months. In 2017, a 3-6 months lasting unsupervised home-based training has been added, which is followed by a 4-week facility-based evaluation and training period, called 'refresher'. We aimed to assess the effectiveness of this programme using a nationwide registry.

METHODS

Anthropometric data, resting blood pressure, lipid profile, maximum exercise capacity (Pmax), anxiety (HADS-A) and depression (HADS-D) of all patients (n=1458) who participated in OUT-III between 1 January 2018 and 30 August 2022 were analysed. Data were assessed at the beginning of OUT-III (OUT-IIIstart), end of the supervised period (OUT-IIIend) and during the refresher (OUT-IIIrefresher).

RESULTS

From OUT-IIIstart to OUT-IIIend, Pmax (155±1.4 W to 167±1.6 W; p<0.001) and high-density lipoprotein (HDL) increased (49±0.4 mg/dL to 51±0.4 mg/dL; p<0.001), low-density lipoprotein (LDL) decreased (82±1.0 mg/dL to 79±1.1 mg/dL; p<0.001), while total cholesterol (CHOL) remained statistically unchanged (150±43.3 mg/dL to 149±43 mg/dL; p<0.999). From OUT-IIIend to OUT-IIIrefresher, Pmax slightly decreased (164±1.6 W; p<0.001), HDL further increased (52±0.5 mg/dL; p<0.020), whereas LDL (79±1.3 mg/dL; p<0.999) and CHOL remained unchanged (149±41 mg/dL; p<0.999).Anxiety (4.8±0.1 aU, 4.2±0.1 aU; p<0.001, 4.0±0.1 aU; p<0.001) and depression (3.7±0.1 aU, 34±0.1 aU; p<.001, 3.1±0.1 aU; p<0.001) continuously decreased from OUT-IIIstart to OUT-IIIend and the OUT-IIIrefresher.

CONCLUSION

OUT-III CR resulted in sustained improvement in Pmax, blood lipids, anxiety and depression.

Machine learning-based return-to-work assessment system for acute myocardial infarction patients within 12 months

BACKGROUND

Returning to work is a critical indicator of recovery after acute myocardial infarction (AMI), and accurate identification of patients with low return-to-work rates is critical for timely intervention.

OBJECTIVES

To develop a machine learning (ML) model for predicting the return-to-work in AMI patients.

METHODS

A retrospective study of data from 539 AMI patients was conducted using the Incidence Rate of Heart Failure After Acute Myocardial Infarction With Optimal Treatment database. Patients were randomly divided into training cohort and validation cohort (7:3). Seven ML algorithms were used to establish a prediction model for the training cohort. Model performance is evaluated by the area under the receiver operating characteristic curve (AUC), accuracy, F1 score, and Brier score.

RESULTS

This study included 539 AMI patients (median [IQR] age, 50.0 [45.0, 54.0] years; 505 (93.7 %) were male, and 431 (80.0 %) returned to work within one year after discharge. The best-performing model was eXtreme gradient boosting, which achieved an AUC of 0.821 (95 % CI, 0.736-0.907), an accuracy of 0.802 (95 % CI, 0.733-0.861), and an F1 score of 0.873. The return-to-work score and stratification established based on this model can effectively distinguish patients into low, medium, and high probability groups (33.3 % vs. 60.0 % vs. 91.7 %, P < 0.001). The model was deployed on an open website https://amirtw.streamlit.app/, providing a convenient evaluation and analysis tool for medical staff.

CONCLUSION

A new return-to-work ML model was developed, which may help identify patients with low return-to-work rates and may become an effective management tool for AMI patients.

Cardiac rehabilitation and physical activity decrease the risk of stroke after acute myocardial infarction: A nationwide cohort study in Sweden

BACKGROUND

Stroke and acute myocardial infarction (AMI) rank among the leading causes of mortality. Physical activity and exercise are recommended as part of rehabilitation after AMI to prevent cardiovascular events, but the importance for stroke prevention has not been investigated using population-based data.

OBJECTIVES

To determine associations between participation in exercise-based cardiac rehabilitation (EBCR) and self-reported physical activity with the risk of total stroke, ischemic stroke, and intracerebral hemorrhage after AMI.

METHODS

This was a nationwide, double cohort study conducted across all coronary care units in Sweden between 2005 and 2020, combined with registered data from the general population. Participation in EBCR (24 physiotherapist-led sessions over 4 months) and self-reported physical activity were assessed at a median of 55 days (range 28-90) after hospital discharge. Stroke incidence was followed until death or censoring on December 31, 2021.

RESULTS

A total of 86,637 people with AMI (mean age 64.0, SD 9.0 years; 26 % female), and 259,911 (1:3) age, sex, and region of birth matched individuals from the general population were included. Participation in EBCR after AMI was associated with a lower risk of total stroke (adjusted hazard ratio, aHR 0.85; 95 % confidence interval, CI 0.80-0.91) compared to non-participants, as was ≥150 min of physical activity per week (aHR 0.79, 95 % CI 0.75-0.83). Those reporting physical activity 6 days per week after AMI did not have an increased risk of total stroke or ischemic stroke compared to the general population (aHR 1.03, 95 % CI 0.87-1.23; and aHR 1.17, 95 % CI 0.97-1.41), and were at lower risk of intracerebral hemorrhage (aHR 0.59, 95 % CI 0.35-0.98).

CONCLUSIONS

EBCR and higher levels of physical activity are associated with a decreased risk of stroke after AMI. Cardiac rehabilitation programs and regular and physical activity should be promoted after AMI to decrease the burden of stroke. Swedish Ethical Review Authority Registration number: 2021-03645.

Effects of exercise-based interventions on health-related quality of life in adults after cancer: A systematic review and meta-analysis

BACKGROUND

Due to the lack of available knowledge in the current literature, this systematic review and meta-analysis was aimed to assess the effectiveness of exercise-based lifestyle interventions, including healthy diet and/or psychological well-being on mental, physical and global health-related quality of life (HRQoL) in adults after cancer treatment.

METHODS

MEDLINE (via PubMed) and Web of Science databases were searched for randomised controlled trials (RCTs) published until August 2024 evaluating exercise-based lifestyle interventions, including healthy diet and/or psychological well-being, which assessed mental, physical and global HRQoL.

RESULTS

Of 6193 screened studies, 32 RCTs met the criteria. The total sample comprised 5528 participants (3003 intervention and 2525 control). There was a small effect size in a pooled analysis that found exercise-based lifestyle interventions improve mental HRQoL (d 0.11, 95 % CI 0.05 to 0.18). These effects were greater in those studies that combined exercise with psychological well-being (d = 0.19, P = 0.004), and with moderate-to-high intensity aerobic exercise (moderate intensity; d = 0.11, P = 0.02, high intensity; d = 0.16, P = 0.02, aerobic exercise; d = 0.16, P = 0.26).

CONCLUSIONS

Exercise-based lifestyle interventions do not enhance physical nor global HRQoL, yet those combined with psychological well-being seem to improve mental HRQoL in individuals after cancer treatment.

PROSPERO REGISTRATION NUMBER

CRD42022369169.

Exploring ways to improve completion of cardiac rehabilitation in areas of high deprivation

BACKGROUND

Cardiac rehabilitation (CR) completion rates are higher in patients living in areas of low deprivation than in those living in areas of high deprivation, widening the health inequality gap.

AIM

A service evaluation was undertaken in the Coventry CR Service to explore the barriers to and facilitators of service completion among patients living in high-deprivation areas, to understand the most important factors to consider when undertaking service improvements.

DESIGN

A process map was completed of the current service. Patients' postcodes were matched with the Index of Multiple Deprivation and used to categorise a high-deprivation area. Purposive recruitment of patients took place during CR clinic appointments. Service users were then interviewed using a semi-structured questionnaire on discharge from the service, and enrolment was stopped at data saturation. Thematic analysis was used. The service was evaluated using the World Health Organization Building Blocks Framework and themes reviewed in terms of service delivery, health workforce, information, technology, and financing.

PARTICIPANTS

Twelve patients who took part in CR between May and August 2022 were interviewed. Facilitators of completion included: personalised CR programmes, work flexibility, social aspects, relating to others, enjoyment, staff and patient education. Barriers included: family commitments, work, not relating to others, parking, the gym environment and poor communication.

CONCLUSION

The two main ways the service could be improved to increase completion is to enhance programme flexibility and patient education in the home-based programme. Investment in technology may mean that facilitators of the gym-based programme, such as monitoring, two-way communication and exercise progression, can be replicated at home.

Optimized Feature Selection and Deep Neural Networks to Improve Heart Disease Prediction

Heart disease remains a significant health threat due to its high mortality rate and increasing prevalence. Early prediction using basic physical markers from routine exams is crucial for timely diagnosis and intervention. However, manual analysis of large datasets can be labor-intensive and error-prone. Our goal is to rapidly and reliably anticipate cardiac disease using a variety of body signs. This research presents a unique model for heart disease prediction. We provide a system for predicting cardiac disease that blends the deep convolutional neural network with a feature selection technique based on the LinearSVC. This integrated feature selection method selects a subset of characteristics that are strongly linked with heart disease. We feed these features into the deep conventual neural network that we constructed. Also to improve the speed of the predictor and avoid gradient varnishing or explosion, the network's hyperparameters were tuned using the random search algorithm. The proposed method was evaluated using the UCI and MIT datasets. The predictor is evaluated using a number of indicators, such as accuracy, recall, precision, and F1 score. The results demonstrate that our model attains accuracy rates of 98.16%, 98.2%, 95.38%, and 97.84% in the UCI dataset, with an average MCC score of 90%. These results affirm the efficacy and reliability of the proposed technique to predict heart disease.

Dyadic Coping, Resilience and Post-Traumatic Growth in Young and Middle-Aged Coronary Heart Disease Patients and Their Spousal Caregivers: An Actor-Partner Interdependence Mediation Model

AIMS

This study was to explore the mediating effect of resilience on the relationship between dyadic coping and post-traumatic growth in patient-spousal caregiver dyads living with coronary heart disease (CHD).

DESIGN

A cross-sectional study was conducted from December 2022 to June 2023.

METHODS

Three hundred eighteen young and middle-aged patient-spousal caregiver dyads from a tertiary hospital in China participated. The dyadic participants were evaluated using self-report questionnaires on dyadic coping, resilience and post-traumatic growth.

RESULTS

A significant actor effect was observed, in which dyadic coping in patients was associated with their own post-traumatic growth; this relationship was partially mediated by both the patient's and the partner's resilience. Furthermore, in the examination of partner effects, the association between dyadic coping in spousal caregivers and post-traumatic growth in patients was found to be completely mediated by the resilience of both the patients and the caregivers.

CONCLUSION

The findings suggest that the dyadic coping, resilience and post-traumatic growth of patients and their spousal caregivers display interactive effects. Healthcare providers treating CHD should regard patient-spousal caregiver dyads as a whole and implement interventions that focus on improving positive dyadic coping and resilience to promote post-traumatic growth.

IMPACT

This paper found that the patients with CHD and their spousal caregivers exhibited low levels of post-traumatic growth, with both groups demonstrating mediating and interactive effects via resilience. The findings offer valuable insights to support the early primary identification and implementation of more effective intervention strategies aimed at fostering post-traumatic growth in CHD patient-spousal caregiver dyads.

PATIENT OR PUBLIC CONTRIBUTION

Not applicable.

Telemedicine-supported lifestyle intervention for glycemic control in patients with CHD and T2DM: multicenter, randomized controlled trial

Patients with coronary heart disease (CHD) and type 2 diabetes mellitus (T2DM) have a substantially increased risk for major cardiovascular events and mortality. Increasing physical activity and improving a healthy diet may effectively reduce cardiovascular risk factors; however, the effects are often transient. In a multicenter, 1:1 randomized controlled trial including 502 patients with combined CHD and T2DM (68 ± 8 years; 84% men), we assessed the effects of a home-based telemedicine-supported lifestyle intervention (exercise training, nutritional recommendations and health literacy training) with regular individualized feedback versus usual care. The study met its primary endpoint of reduced glycated hemoglobin after 6 months in favor of the lifestyle intervention group (mean between-group difference in the complete-case analysis (n = 197 and n = 193), -0.13% (95% confidence interval, -0.25 to -0.01), P = 0.04). When individualized feedback and health literacy training were discontinued after 6 months (while other telemedicine tools were maintained), no statistically significant between-group differences were observed at 12 months. At 12 months, 31 patients (6.2%) had a major adverse cardiovascular event (lifestyle intervention, n = 20 (8.0%); usual care, n = 11 (4.4%); P = 0.15), with the main reason being hospitalization for angina or revascularization (lifestyle intervention, n = 15; usual care, n = 8). There were five deaths (lifestyle intervention, n = 2; usual care, n = 3), none of which were categorized as related to the intervention. However, three events that resulted in hospitalization were categorized as potentially related to the intervention (decompensation of heart failure, vertebral disc prolapse and inguinal hernia). In conclusion, a home-based lifestyle intervention with telemedicine support showed modest effects in patients with CHD and T2DM. ClinicalTrials.gov registration: NCT03835923 .

Association between quality of discharge teaching and self-management in patients after percutaneous coronary intervention: A chain mediation model

AIMS

To examine chain mediating effect of discharge readiness and self-efficacy between quality of discharge teaching and self-management in patients after percutaneous coronary intervention (PCI).

BACKGROUND

Although self-management after PCI has significant benefits in controlling risk factors and delaying disease progression, the status of self-management remains unoptimistic. A large number of studies have explored the close relationship between the quality of discharge teaching and patients self-management, but little is known about the underlying mechanisms.

METHODS

The cross-sectional samples was collected from a tertiary hospital in China. Self-reported questionnaires were used to assess quality of discharge teaching, discharge readiness, self-efficacy and self-management. Pearson correlation analysis and mediation effect analysis were used for statistical analysis.

REPORTING METHOD

The study used the STROBE checklist for reporting.

RESULTS

A total of 198 patients with a mean age of 64.99 ± 11.32 (34-85) were included. The mean score of self-management was 88.41 ± 11.82. Quality of discharge teaching, discharge readiness, self-efficacy and self-management were all positively correlated. Mediation effect analysis showed that the mediating effects of discharge readiness, self-efficacy, discharge readiness and self-efficacy between quality of discharge teaching and self-management were 0.157, 0.177 and 0.049, respectively, accounting for 21.96%, 24.76% and 6.85% of the total effect.

CONCLUSION

The quality of discharge teaching for patients after PCI not only directly affects self-management, but also can indirectly affect self-management through discharge readiness and self-efficacy.

RELEVANCE TO CLINICAL PRACTICE

To improve the life quality of patients after PCI, medical staff should pay attention to the influence of self-management of quality of discharge teaching, and develop intervention strategies based on the path of discharge readiness and self-efficacy.

PATIENT OR PUBLIC CONTRIBUTION

Questionnaires filled out by patients were used to understand the association between quality of discharge teaching, discharge readiness, self-efficacy and self-management.

2025 ACC/AHA/ACEP/NAEMSP/SCAI Guideline for the Management of Patients With Acute Coronary Syndromes: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines

AIM

The "2025 ACC/AHA/ACEP/NAEMSP/SCAI Guideline for the Management of Patients With Acute Coronary Syndromes" incorporates new evidence since the "2013 ACCF/AHA Guideline for the Management of ST-Elevation Myocardial Infarction" and the corresponding "2014 AHA/ACC Guideline for the Management of Patients With Non-ST-Elevation Acute Coronary Syndromes" and the "2015 ACC/AHA/SCAI Focused Update on Primary Percutaneous Coronary Intervention for Patients With ST-Elevation Myocardial Infarction." The "2025 ACC/AHA/ACEP/NAEMSP/SCAI Guideline for the Management of Patients With Acute Coronary Syndromes" and the "2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization" retire and replace, respectively, the "2016 ACC/AHA Guideline Focused Update on Duration of Dual Antiplatelet Therapy in Patients With Coronary Artery Disease."

METHODS

A comprehensive literature search was conducted from July 2023 to April 2024. Clinical studies, systematic reviews and meta-analyses, and other evidence conducted on human participants were identified that were published in English from MEDLINE (through PubMed), EMBASE, the Cochrane Library, Agency for Healthcare Research and Quality, and other selected databases relevant to this guideline.

STRUCTURE

Many recommendations from previously published guidelines have been updated with new evidence, and new recommendations have been created when supported by published data.

Mitochondrial Dysfunction in HFpEF: Potential Interventions Through Exercise

HFpEF is a prevalent and complex type of heart failure. The concurrent presence of conditions such as obesity, hypertension, hyperglycemia, and hyperlipidemia significantly increase the risk of developing HFpEF. Mitochondria, often referred to as the powerhouses of the cell, are crucial in maintaining cellular functions, including ATP production, intracellular Ca2+ regulation, reactive oxygen species generation and clearance, and the regulation of apoptosis. Exercise plays a vital role in preserving mitochondrial homeostasis, thereby protecting the cardiovascular system from acute stress, and is a fundamental component in maintaining cardiovascular health. In this study, we review the mitochondrial dysfunction underlying the development and progression of HFpEF. Given the pivotal role of exercise in modulating cardiovascular diseases, we particularly focus on exercise as a potential therapeutic strategy for improving mitochondrial function. Graphical abstract Note: This picture was created with BioRender.com.

Cardiac Rehabilitation in TAVI Patients: Safety and Benefits: A Narrative Review

Transcatheter aortic valve implantation (TAVI) has redefined the management of severe aortic stenosis, particularly in surgical high-risk patients. As the number of TAVI procedures increases, there is a growing need for effective post-procedural care. Cardiac rehabilitation (CR) has emerged as a critical component of treatment in these patients. The most recent update of the European recommendations highlights the importance of including post-TAVI patients in CR programs. However, the benefits of CR in this particular patient group still need to be fully understood. The objective of this narrative review is to summarize the safety and benefits of post-TAVI CR by evaluating its impact on functional capacity, frailty, muscular strength, mental health, quality of life, and long-term survival. While emerging evidence supports its safety and effectiveness in the aforementioned outcomes, gaps remain regarding the optimal rehabilitation protocols, including the timing, duration, and intensity of CR as well as its long-term cardiovascular benefits. Further research is needed to develop personalized approaches for different patient groups. This article highlights the current knowledge, identifies critical gaps, and underlines the need for tailored rehabilitation strategies to improve post-TAVI recovery and patient outcomes.

Decreased plasma lipoxin A4, resolvin D1, protectin D1 are correlated with the complexity and prognosis of coronary heart disease: A retrospective cohort study

This study aimed to assess the predictive capacity of specialized pro-resolving mediators (SPMs) regarding the complexity and prognosis of coronary heart disease (CHD). Total of 602 CHD patients were included in this study and categorized into low-risk, medium-risk, and high-risk groups based on the Synergy Between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery (SYNTAX) score. Follow-up was conducted for two years, during which patients were dichotomized into poor and good prognosis groups. Additionally, twenty healthy controls were incorporated. Plasma concentrations of lipoxin A4 (LXA4), resolvin D1 (RvD1), protectin D1 (PD1), C-reactive protein (CRP), interleukin-6 (IL-6), and IL-10 were quantified. Plasma LXA4, RvD1, PD1, and the ratios LXA4/IL-6, RvD1/IL-6, PD1/IL-6 exhibited a gradual decrease across control, low-risk, medium-risk, and high-risk groups and exhibited a negative correlation with the SYNTAX score. Spearman's correlation analysis revealed negative correlations between plasma LXA4, RvD1, PD1, and both CRP and IL-6, and positive correlations with IL-10. Multiple linear regression models demonstrated negative associations between plasma LXA4, RvD1, PD1, and SYNTAX score. Moreover, both univariate and multivariate binary logistic regression analyses identified plasma LXA4, RvD1, and PD1 as protective factors against medium/high-risk SYNTAX score categorization. In the poor prognosis group, plasma PD1 was reduced at short-term follow-up, and the ratios LXA4/IL-6, RvD1/IL-6, PD1/IL-6 were reduced at long-term follow-up. Plasma LXA4, RvD1, and PD1 demonstrated negative correlations with CHD complexity and potentially served as protective factors against CHD. Plasma PD1 provided predictive value for short-term prognosis, while the ratios LXA4/IL-6, RvD1/IL-6, PD1/IL-6 were indicative for long-term prognosis.

[Update on cardiovascular prevention 2025]

Despite an expensive healthcare system Germany performs poorly with respect to life-expectancy compared to other countries, for which cardiovascular diseases and deficits in cardiovascular prevention in particular are responsible. The basis of cardiovascular prevention is a healthy lifestyle with regular physical exercise, a predominantly plant-based diet, nonsmoking, good sleep and mental health. In many cases additional lipid-lowering, antidiabetic and antihypertensive medications are necessary. Recent studies have proven the prognostic effects of different groups of medications, such as proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors, sodium-glucose transporter 2 (SGLT2) inhibitors and glucagon-like peptide 1 (GLP-1) receptor agonists, in the appropriate indication areas. To improve the cardiovascular prevention in Germany, intensified public efforts are crucial. In addition, individual support of patients is effective for long-term preventive measures. To achieve this healthcare professionals must be trained (physicians, cardiovascular prevention assistants), who can sustainably support patients in lifestyle modifications and medicinal prevention.

Electrophoretic digital colorimetry integrated with electrochemical sweat sensor

Recent advancements in wearable sweat sensors, which use standardized electrochemical and colorimetric mechanisms, offer holistic representation of health status for users. However, the constraints of standardized sweat sensors present ongoing challenges to realization of personalized health management. This study presents an electrocolorimetric (EC) platform that enables the reversible and multiple-time use of colorimetric data visualization using electrophoretic display (EPD). This platform represents the application of low-power EPD in epidermal sweat sensor, evaluated through CIELAB-based methodology which is the first systematic evaluation tool of wearable display performance. Moreover, our platform has been demonstrated in human exercise trials for its ability to detect the lactate threshold (LT). This digital colorimetric system has the potential to play a pivotal role by integrating various health monitoring biomarkers. While providing real-time, continuous, and adjustable range information with high sensitivity, this platform validates its extensive probability as a next-generation wearable epidermal sensor.

Depression, Anxiety, and Quality of Life in a Cardiac Rehabilitation Program Without Dedicated Mental Health Resources Post-Myocardial Infarction

Anxiety and depression are common after a myocardial infarction (MI), so psychological and psychiatric mental health (MH) interventions are recommended during Cardiac Rehabilitation Programs (CRP). We aim to evaluate anxiety and depression symptoms and quality of life in MI sufferers followed in a CRP without dedicated MH resources. We prospectively included 164 MI patients in our CRP without dedicated MH resources. Patient Health Questionnaire 2-item (PHQ-2) and Generalized Anxiety Disorder 2-item (GAD-2) questionnaires for depression and anxiety screening (altered if ≥3 points) and the 36-Item Short Form Survey Instrument (SF-36) to analyze four MH components and Mental Component Summary (MCS) were assessed at the beginning and after CRP. The mean age was 61.35 ± 10.76 years, and most patients were male (86.6%). A significant improvement in SF-36 mental components (from +5.94 ± 27.98 to +8.31 ± 25 points, p < 0.001) and SF-36-MCS (+1.85 ± 10.23 points, p = 0.02) was noted, as well as a reduction in depression and anxiety symptoms in PHQ-2 and GAD-2 (p < 0.001). However, 33 (20.1%) patients showed a positive screening for depression and/or anxiety at the end of the program. These patients were younger (56.6 ± 8.05 vs. 62.55 ± 11.05 years, p = 0.004) and showed significantly worse initial scores of SF-36 mental components, PHQ-2, and GAD-2 (p < 0.001). We conclude that a Phase 2 CRP without dedicated MH resources can achieve significant improvements in MH well-being after MI. However, one-fifth of the population had substantial depression and/or anxiety symptoms at the end of the program. This subset, characterized by worse initial MH scores, may benefit from specific MH interventions during CRP.

Exercise-based cardiac rehabilitation for patients undergoing coronary artery operation: a systematic review and meta-analysis based on current randomized controlled trials

BACKGROUND

Currently, exercise-based cardiac rehabilitation (CR) has been receiving increasing interest for its potentially beneficial effects on the health related quality of life (HRQoL) and outcomes of patients with coronary heart disease (CHD). The aim of this study was to evaluate the effect of exercise-based CR on patients after coronary artery bypass graft (CABG) and percutaneous coronary interventions (PCI).

METHODS

We searched PubMed, Embase, Cochrane Library, and Web of Science from inception to 1 December 2023 for relevant studies that evaluated the effect of exercise-based CR on patients after CABG and PCI. Our primary outcomes included mortality, complications, hospital admissions, and HRQoL between patients receiving exercise-based CR and usual care. All statistical analyses were performed using the standard statistical procedures provided in Review Manager 5.2 and Stata 12.0.

RESULTS

We finally indicated and included 25 randomized controlled trials (RCTs) with 4106 participants for the present analysis. Our pooled results indicated that, compared to usual care, exercise-based CR did not increase the all-cause (relative risk, RR: 0.84; 95% confidence interval, CI: 0.54-1.31) and cardiovascular (RR: 0.98; 95% CI: 0.38-2.54) mortality for patients after coronary artery operation. Similarly, exercise-based CR had an equal effect on coronary artery complications for patients after coronary artery surgery, including CABG (RR: 0.60; 95% CI: 0.32 ‒ 1.15) and PCI (RR: 0.92; 95% CI: 0.55-1.54). It was indicated that exercise-based CR significantly reduced the incidence of myocardial infarction (MI) by half with an RR of 0.50 (95% CI: 0.28-0.90). In addition, exercise-based CR also significantly reduced all-cause hospital admissions with an RR of 0.74 (95% CI: 0.62-0.88). Compared to usual care, exercise-based CR obviously improved HRQoL of patients after coronary artery operation evaluated with SF-36 summary scores (standardized mean difference, SMD: 0.24; 95% CI: 0.11-0.38) and SF-36 8 domains (SMD: 0.35; 95% CI: 0.24-0.46).

CONCLUSIONS

Our analysis indicated that exercise-based CR had a significant effect on the improvement of HRQoL in patients after coronary artery surgeries without increasing mortality or the incidence of re-intervention with operations.

Cardiovascular and Risk Factor Outcomes for Ethnic Minorities From Cardiac Rehabilitation: A Systematic Review and Meta-Analysis

PURPOSE

To determine the benefits of cardiac rehabilitation (CR) among ethnic minorities for cardiovascular risk factors (systolic blood pressure [BP], exercise capacity, lipids, body fat), mortality, and morbidity, and compare outcomes to majority reference groups.

REVIEW METHODS

We searched electronic databases (Medline, EMBASE, CINAHL, Scopus, Cochrane Library) from inception until September 2023 for studies reporting CR outcomes of ethnic minorities. Meta-analyses were conducted for data that could be pooled using random effects model. Data that were not suitable for meta-analysis were synthesized and reported narratively.

SUMMARY

Thirteen studies with a total of 132 109 participants (10 494 from ethnic minorities [8% of total participants]) were included. Patients from ethnic minority groups made improvements in several outcomes post-CR. These outcomes were equivalent to majority groups for systolic BP (Mean Difference [MD] = -0.69: 95% CI, -1.62 to 0.24 mmHg), maximal exercise capacity (MD = -0.10: 95% CI, -0.63 to 0.44 metabolic equivalents of task), total cholesterol (MD = 0.16: 95% CI, -0.01 to 0.33 mmol/L), and low-density lipoprotein cholesterol (MD = 0.25: 95% CI, -0.04 to 0.54 mmol/L). However, ethnic minorities achieved less improvements than the majority for body mass index (MD = -0.31: 95% CI, -0.47 to -0.14 kg/m2) and waist circumference (MD = -1.50: 95% CI, -2.33 to -0.68 cm). Narrative synthesis indicated equivalent outcomes for minorities for all-cause mortality and mean cholesterol, with worse risk of hospitalization at 1 year. Patients from ethnic minorities attending CR achieve equivalent benefits to majority counterparts for multiple risk factors and potentially mortality and morbidity, therefore CR should be strongly promoted. Individual tailoring may be needed to address adiposity and exercise capacity.

Exercise Training After Myocardial Infarction Enhances Endothelial Progenitor Cells Function via NRG-1 Signaling

Vascular regeneration after myocardial infarction (MI) is essential to improve myocardial ischemia, delay post-infarction ventricular remodeling, and improve the long-term prognosis of MI. Endothelial progenitor cells (EPCs) play important roles in the functional repair and homeostatic maintenance of the vascular endothelium. Exercise training stimulates EPC mobilization and increases the number of circulating EPCs, which has beneficial effects on the restoration of vascular integrity and hemodynamic reconstitution. After post-MI exercise training, cardiac function, the myocardial infarct area, and capillary density in the peri-infarct zone were measured. Bone marrow-derived EPCs were isolated from mice to measure the proliferation, migration, and in vitro angiogenesis of EPCs after myocardial infarction exercise. The expression of NRG-1/ErbB4 signaling factor and related proteins in downstream PI3K/AKT signaling pathway were detected, and the level of autocrine NRG-1 in EPCs was detected. Post-MI resistance training, aerobic exercise training, and combined exercise training increased EPC mobilization and proliferation, migration, and tube-forming capacity, promoted myocardial vascular regeneration, improved cardiac function, and reduced infarct size. Exercise training upregulated NRG-1 expression in EPCs, and NRG-1/ErbB4 signaling activated the downstream PI3K/Akt signaling pathway. Moreover, EPCs may have a positive feedback autocrine loop with NRG-1 to improve the function of EPCs and promote vascular repair and regeneration in mice with MI. Exercise training after MI promotes the function of bone marrow-derived EPCs through NRG-1/ErbB4/PI3K/AKT signaling, thus exerting a role in angiogenesis.

2025 ACC/AHA/ACEP/NAEMSP/SCAI Guideline for the Management of Patients With Acute Coronary Syndromes: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines

AIM

The "2025 ACC/AHA/ACEP/NAEMSP/SCAI Guideline for the Management of Patients With Acute Coronary Syndromes" incorporates new evidence since the "2013 ACCF/AHA Guideline for the Management of ST-Elevation Myocardial Infarction" and the corresponding "2014 AHA/ACC Guideline for the Management of Patients With Non-ST-Elevation Acute Coronary Syndromes" and the "2015 ACC/AHA/SCAI Focused Update on Primary Percutaneous Coronary Intervention for Patients With ST-Elevation Myocardial Infarction." The "2025 ACC/AHA/ACEP/NAEMSP/SCAI Guideline for the Management of Patients With Acute Coronary Syndromes" and the "2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization" retire and replace, respectively, the "2016 ACC/AHA Guideline Focused Update on Duration of Dual Antiplatelet Therapy in Patients With Coronary Artery Disease."

METHODS

A comprehensive literature search was conducted from July 2023 to April 2024. Clinical studies, systematic reviews and meta-analyses, and other evidence conducted on human participants were identified that were published in English from MEDLINE (through PubMed), EMBASE, the Cochrane Library, Agency for Healthcare Research and Quality, and other selected databases relevant to this guideline.

STRUCTURE

Many recommendations from previously published guidelines have been updated with new evidence, and new recommendations have been created when supported by published data.

Exercise Training and Cardiac Rehabilitation in Patients After Percutaneous Coronary Intervention: Comprehensive Assessment and Prescription

Current guidelines on acute and chronic coronary syndromes recommend comprehensive and multidisciplinary exercise-based cardiac rehabilitation in Class I. Indeed, in patients after a percutaneous coronary intervention, this supervised and structured rehabilitation program improves cardiovascular risk and reduces adverse events and mortality. After an initial assessment, including a peak exercise capacity evaluation, patients follow a tailored multidisciplinary program consisting of aerobic and resistance exercise training, risk factor management, dietary counselling, physical activity counselling, weight control management, psychosocial support, and education. However, tailored management and exercise prescription require careful assessment and risk consideration of several variables such as left ventricular dysfunction, comorbidities, aging, coronary artery disease severity, physical activity capacity, and type of coronary syndrome. The functional and prognostic benefits of cardiac rehabilitation have been widely demonstrated in patients after a percutaneous coronary intervention; however, referral is still limited, although exercise should be strongly recommended to these patients in the context of cardiovascular prevention. Therefore, the aim of our article is to provide an updated, critical, and state-of-the-art review of exercise training and cardiac rehabilitation programs in patients after a percutaneous coronary intervention. Furthermore, practical approaches to the management of these patients with a multidisciplinary and personalized intervention will be provided.

The sentinels of coronary artery disease: heterogeneous monocytes

Monocytes are heterogeneous immune cells that play a crucial role in the inflammatory response during atherosclerosis, influencing the progression and outcome of the disease. In the pathogenesis of atherosclerotic diseases, such as coronary artery disease (CAD), monocytes not only serve as the initial sensors of endogenous and exogenous pathogenic factors, but also function as intermediators that bridge the circulatory system and localized lesions. In the bloodstream, heterogeneous monocytes, acting as sentinels, are rapidly recruited to atherosclerotic lesions, where they exhibit a heightened capacity to respond to various pathological stimuli upon detecting signals from damaged vascular endothelial cells. Clinical studies have demonstrated that the heterogeneity of monocytes in CAD patients presents both diversity and complexity, varying across different disease subtypes and pathological stages. This review explores the heterogeneity of monocytes in CAD, focusing on alterations in monocyte subset numbers, proportions, and the expression of functional receptors, as well as their correlations with clinical features. Additionally, we propose strategies to enhance the clinical utility value of monocyte heterogeneity and outline future research directions in the field of CAD. With the widespread application of high-parameter flow cytometry and single-cell sequencing technologies, it is anticipated that a comprehensive understanding of monocyte heterogeneity in CAD will be achieved, enabling the identification of disease-specific monocyte subtypes. This could offer new opportunities for improving the diagnosis and treatment of CAD.

Heart2Heart: a digital peer support programme for people with heart disease: protocol for a community-based, investigator-blinded randomised controlled trial conducted in Australia

INTRODUCTION

Cardiac rehabilitation is known to reduce morbidity and improve quality of life in people living with heart disease, however, adherence, access and completion of these programmes is suboptimal. Peer support may offer an opportunity to close this service gap. The aim of the study is to determine whether the effectiveness of a digital peer support programme for people living with heart disease is effective in improving social connectedness, clinical and patient-reported outcomes and experience measures.

METHODS AND ANALYSIS

Heart2Heart is a community-based randomised controlled trial with 6 months follow-up for the primary outcome and 6 and 12 months for secondary outcomes. Approximately 752 adults with a diagnosis of heart disease in the past 12 months will be recruited from the general community and Australian cardiac rehabilitation programmes. Control group will participate in usual care, while intervention group will have access to a 6 months intervention that enables peer support via an interactive mobile application, in addition to usual care. The intervention includes online discussion groups, access to resources and facilitated conversations with health professionals. Primary outcome is social connectedness at 6 months follow-up. Secondary outcomes (6 and 12 months) will be all-cause/cardiovascular disease hospital admissions, all-cause mortality, lifestyle (sufficiently physically active, not smoking, sufficient fruit and vegetable consumption), proportion taking prescribed medications and health service utilisation (medical appointments, cardiac rehabilitation, participation in any other in-person peer support activities). Patient-reported outcome and experience measures including self-efficacy, quality of life, satisfaction and programme engagement will be analysed at 6 months. Process measures will include application analytics, barriers and facilitators to engagement with the intervention from participant's perspective. An intention-to-treat analysis will be used.

ETHICS AND DISSEMINATION

Ethical clearance was obtained from Western Sydney Local Health District Ethics Committee. Heart2Heart has potential to improve social connectedness and provide a valuable addition to traditional cardiac rehabilitation.

TRIAL REGISTRATION NUMBER

ACTRN12624000386538.

Network pharmacology to unveil the blood components and mechanisms of Tongmai Yangxin Pills in treating elderly coronary heart disease

Background

Tongmai Yangxin Pills (TMYXP) is a well-known traditional Chinese medicine compound to treat coronary heart disease (CHD). Aging is a key immutable independent risk factor for CHD. Currently, there are few gene expression profiles of patients treated with traditional Chinese medicine (TCM) or TCM compound. However, the chemical composition and underlying mechanisms of TMYXP against elderly CHD need to be elucidated.

Objective

Exploring the mechanism of TMYXP in treating elderly CHD based on human gene expression profiles, and find the key pharmacodynamic ingredients of TMYXP in treating elderly CHD based on plasma pharmacochemistry and network pharmacology.

Methods

A strength of this study is the use of network pharmacology analysis of gene expression profiles in elderly CHD patients before and after TMYXP treatment. This study focused on peripheral blood mononuclear cell samples from 6 elderly patients with CHD over 60 years old (GSE142008). A total of 40 blood components of TMYXP identified by UPLC/Q-TOF-MS method in the plasma of SD rats. Then, we collected literature-validated TMYXP blood component targets for further network pharmacology analysis.

Results

All blood components of TMYXP exhibited non-toxic properties. By retrieving validated TMYXP blood components's targets, 15 blood components correspond to a total of 4,789 targets. Genistein, emodin, isoliquiritigenin, glycyrrhizic acid, gallic acid, verbascoside, calycosin, rhein, formononetin and ephedrine were the most potential anti-CHD blood components in TMYXP. The above 10 key blood components of TMYXP mainly regulate hub genes CASP3, TGFB1, PTGS2, CXCL8, FAS and JAK2, mediating multiple mechanisms to treat elderly CHD. TMYXP exerts anti-CHD effects on the TNF signaling pathway, PI3K-Akt signaling pathway, p53 signaling pathway, MAPK signaling pathway, lipid and atherosclerosis, NOD-like receptor signaling pathway, diabetic cardiomyopathy and cytokine-cytokine receptor interaction. We further used molecular docking technology to verify the direct interaction of TMYXP blood components with its hub target for treating elderly CHD.

Conclusion

This study builds a bridge connecting TMYXP blood components and its confirmed clinical efficacy, identifies a series of anti-CHD lead compounds, and analyzes their possible mechanisms for treating CHD. The research strategy of this study has the potential to promote the modernization and transformation of TCM and promote the drug development.

Development and psychometric testing of the family caregiver self-efficacy scale for patients in the early post-coronary artery bypass grafting

BACKGROUND AND OBJECTIVES

Family caregiver self-efficacy plays an important role in improving the health and quality of life of patients in the early post-coronary artery bypass grafting (CABG). However, there is a lack of targeted self-efficacy assessment tool for caregivers of patients. Thus, the purpose of this study was to develop a Family Caregiver Self-Efficacy Scale for patients in the early post-CABG (FCSES-EPCABG) and to test its reliability and validity.

METHODS

Based on self-efficacy theory, the initial scale was formed by the literature review, semi-structured interviews, Delphi expert consultation, and pre-survey. Through the convenience sampling method, 133 caregivers who met the selection criteria were chosen for the questionnaire survey at Wuhan Asian Heart Hospital from January 2024 to May 2024. The aim was to test the reliability and validity of the scale.

RESULTS

The final scale contained five dimensions of wound care, medication management, cardiac rehabilitation management, social support, and self-care, with a total of 22 items. The item-level content validity index ranged from 0.889 to 1.000, the scale-level content validity index/average was 0.985, and the content validity ratio ranged from 0.778 to 1.000. The exploratory factor analysis showed that the cumulative variance contribution rate of the five dimensions was 69.433%. In the criterion-related validity analysis, the total score of the FCSES-EPCABG was positively correlated with the total score of the General Self-Efficacy Scale (r = 0.762, P<0.001). The Cronbach's alpha coefficient of the scale was 0.919, the half reliability was 0.779, and the test-retest reliability was 0.936.

CONCLUSION

The FCSES-EPCABG has satisfactory reliability and validity, which is suitable for evaluating the self-efficacy of family caregivers of patients in the early post-CABG.

Impact of exercise-based cardiac rehabilitation on cardiopulmonary function and prognosis in ST elevation myocardial infarction after PCI patients in extremely cold regions

PURPOSE

To evaluate the impact of exercise-based cardiac rehabilitation (CR) on the cardiopulmonary function and prognosis in post-percutaneous coronary intervention (PCI) patients with ST elevation myocardial infarction (STEMI) in extremely cold regions of China.

METHODS

This retrospective study included 2,162 patients diagnosed with STEMI who were treated at five medical centers in extremely cold regions of China, between January 2020 and December 2023. All included patients underwent emergency coronary angiography and PCI. Based on whether they received exercise-based CR, patients were divided into a CR group and a non-CR group. To adjust for variations in initial risk factors and baseline characteristics between patients who underwent CR or not, we employed the propensity score matching. Each patient was matched in a 1:1 ratio with replacement. Patients who either participated in CR or did not, but could not be adequately matched, were excluded from the study population. Patient information between the two groups was systematically compared in hospital and at follow-up.

RESULTS

The rate of heart failure, re-hospitalization, and ventricular arrhythmia in CR group was significantly lower than that in non-CR group. The left ventricular ejection fraction (LVEF) measured by echocardiography in CR group were significantly higher than those in non-CR group. The cardiopulmonary test indicators for patients in CR group showed significant improvement over one year, including Power, HR, VCO₂, VO₂, VE, VD/VT, PetCO₂, CHO, CO, and SV, all with statistical significance. Multivariate COX regression analysis showed that CR was independently associated with heart failure in follow up.

CONCLUSION

Exercise-based CR effectively improves the recovery of cardiac function and prognosis in post-PCI patients with STEMI in extremely cold regions of China.

Exploring high-protein diets in the context of cardiac rehabilitation

The review aims to explore the potential benefit and risk of high-protein diets (HPD) regarding the comorbidity of sarcopoenia and CVD in the setting of cardiac rehabilitation (CR). CR is standard care for individuals who have experienced a cardiac event, but the current practice of predominantly aerobic exercise, a lower-fat diet and weight loss poorly addresses the issue of sarcopoenia. HPD, especially when combined with resistance exercise (RE), may be valuable adjuncts to current CR practice and benefit both muscle and cardiovascular health. Meta-analyses and randomised controlled trials of HPD and CVD risk show beneficial but variable effects regarding weight loss, the lipid profile, insulin resistance and lean body mass in those living with or high risk of CVD. Meta-analyses of prospective cohort studies on hard CVD endpoints favour lower- and plant-protein diets over higher animal protein, but the evidence is inconsistent. HPD augment the strength and muscle gaining benefits of RE in older populations, but there are no published data in those living with CVD providing promising opportunities for CR research. HPD raise concern regarding renal and bone health, the microbiome, branched chain amino acids and environmental sustainability and findings suggest that plant-based HPD may confer ecological and overall health advantages compared to animal-based HPD. However, incorporating RE with HPD might alleviate certain health risks. In conclusion, a largely plant-based HPD is deemed favourable for CR when combined with RE, but further research regarding efficacy and safety in CR populations is needed.

Comprehensive review of myocardial injury after noncardiac surgery: prevention, intervention, and long-term management strategies

Myocardial Injury after Noncardiac Surgery (MINS) is an increasingly recognized complication that significantly impacts postoperative morbidity and mortality. Characterized by elevated cardiac troponin levels without overt ischemic symptoms, MINS presents a challenge in perioperative care. This review article explores the epidemiology, etiology, and management of MINS, with a particular focus on prevention and the latest management strategies. We discuss the role of aspirin, statins, anticoagulation, and Dual Antiplatelet Therapy (DAPT) within the context of MINS, drawing on evidence from notable clinical trials as well as observational studies. Despite advancements in understanding and managing MINS, the condition continues to be associated with high mortality and major adverse cardiovascular events (MACE), underscoring the need for ongoing research and development of more effective management protocols.

Modifiable risk factors and self-reported health after percutaneous coronary intervention: with and without a history of atrial fibrillation

AIMS

Atrial fibrillation (AF) and coronary artery disease have several common risk factors, and 10-15% of patients with AF undergo percutaneous coronary intervention (PCI). Little is known about changes over time in modifiable risk factors and self-reported health in patients with and without a history of AF after PCI. Therefore, the aims were to determine and compare changes in modifiable risk factors and self-reported health in patients with and without a history of AF after PCI.

METHODS AND RESULTS

CONCARDPCI, a prospective multi-centre cohort study including patients after PCI, was conducted at seven high-volume PCI centres in Norway and Denmark (n = 3417). Of these, 408 had a history of AF. Data collection was conducted at the index admission and at 2-, 6-, and 12 months after discharge. Self-reported health was assessed with RAND-12 and the myocardial infarction dimensional assessment scale. Patients with a history of AF reported poorer health at baseline. However, the physical (P = 0.012) and mental (P < 0.001) health improved over time in both groups. The patients with a history of AF reported more emotional reactions (P = 0.029) and insecurities (P = 0.015). The proportion of smokers increased from 2- to 12 months in patients with a history of AF (P = 0.041), however, decreased in patients without AF from baseline to 6 months (P < 0.001).

CONCLUSION

An intensified focus on lifestyle interventions is needed to improve modifiable risk factors and self-reported health in patients with and without a history of AF after PCI.

Classification of kinesiophobia in patients after cardiac surgery under extracorporeal circulation in China: latent profile and influencing factors analysis from a cross-sectional study

OBJECTIVE

To investigate the potential classification of kinesiophobia in patients after cardiac surgery under extracorporeal circulation from a psychosocial perspective, and analyse the characteristic differences among different latent levels of patients.

STUDY DESIGN

This is a cross-sectional study of Chinese adults after cardiac surgery under extracorporeal circulation, aged 18 years and older, recruited from a tertiary hospital in North China.

METHODS

This study uses latent profile analysis to identify potential classifications of kinesiophobia in questionnaires from 348 patients undergoing cardiac surgery under extracorporeal circulation. Multiple logistic regression analysis was used to evaluate the influencing factors at different latent classifications.

RESULTS

The average performance of each indicator in Model 3 is best suited for analysis, Entropy=0.873 and bootstrap likelihood ratio test (p)＜0.0001. The result of regression equation shows postoperative time (p<0.001), age, self-efficacy, pain and social support level (p<0.05) were the factors influencing the potential profile classification of patients after cardiac surgery under extracorporeal circulation.

CONCLUSION

The study identified three distinct classifications of patients: the low kinesiophobia group, the moderate kinesiophobia-high-risk perceived symptoms group and the high kinesiophobia-high exercise avoidance group (HK-HEAG). Addressing kinesiophobia, especially in older male patients during the early postoperative period, is crucial. Enhancing self-efficacy seems effective in reducing kinesiophobia, while increasing social support may not be as beneficial for the HK-HEAG. These findings provide a basis for implementing preventive interventions in cardiac rehabilitation.

TRIAL REGISTRATION NUMBER

The research is registered with the Chinese Clinical Trial Registry (ChiCTR2200057895).

Acceptance of Illness and Health-Related Quality of Life in Patients After Myocardial Infarction-Narrative Review

Introduction: Cardiovascular diseases, particularly myocardial infarction (MI), significantly impact patients' lives, causing stress and prompting varied responses to illness. Aim and methods: We conducted a narrative review concerning the acceptance of illness and quality of life in post-MI patients. Based on an extensive search of the available literature, this review consolidates current evidence on the proposed topic. Conclusions and implications: While some patients struggle with acceptance and face emotional distress, others who accept their condition are more likely to engage in treatment and lifestyle changes, leading to an improved health-related quality of life (HRQoL). Following an MI, patients often experience depression, anxiety, and stress, complicating their acceptance of the illness. Risk factors, such as hypertension, diabetes, and smoking, play a significant role in influencing HRQoL in post-MI patients. An accurate assessment of HRQoL is crucial for tailoring effective treatments and support strategies to enhance patient outcomes and identify those most at risk of developing post-MI depression or anxiety. Effective physician-patient and nurse-patient communication and support from family might be helpful in recovery. Cardiac rehabilitation improves patients' outcomes and HRQoL. This review underscores the importance of integrating psychological support with optimal medical care to improve patient prognosis and enhance the HRQoL of individuals recovering from MI. The healthcare system could implement routine psychological assessments for MI patients at admission and discharge to establish a baseline for follow-up. Future research should explore effective psychological interventions, the interplay of CVD risk factors and psychosocial aspects, the emerging role of artificial intelligence in personalized care, and the cost-effectiveness of integrated treatment models.

Pharmacotherapy, Lifestyle Modification, and Cardiac Rehabilitation after Myocardial Infarction or Percutaneous Intervention

Coronary artery disease is the leading cause of death in the US, and approximately 25% of MIs occurring each year are reinfarctions. Due to advances in percutaneous coronary intervention (PCI) and medical therapy, patients with prior MIs live longer but may be susceptible to additional cardiac events. Thus, secondary prevention after MI or PCI is key to improving mortality and quality of life. This review discusses pharmacotherapies and lifestyle interventions with a special focus on cardiac rehabilitation in the post-MI or PCI period to improve cardiovascular outcomes.

The effects of exercise-based prehabilitation in patients undergoing coronary artery bypass grafting surgery: A systematic review of randomized controlled trials

BACKGROUND

Postoperative exercise-based rehabilitation improves the physical performance and health-related outcomes of patients undergoing coronary artery bypass grafting (CABG). However, the effectiveness of exercise-based prehabilitation in patients undergoing CABG remains unknown.

OBJECTIVE

The purpose of this systematic review was to investigate the effects of exercise-based prehabilitation on functional exercise capacity, postoperative complications, anxiety, depression, self-efficacy, quality of life, length of hospital and intensive care unit stay, frailty, and endothelial function in patients undergoing CABG surgery.

METHODS

This systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The study protocol is recorded in the PROSPERO database (registration number CRD42023488530). PubMed, the Physiotherapy Evidence Database (PEDro), Google Scholar, Web of Science, Scopus, and the Cochrane Library were searched from inception to December 2023. The titles and abstracts of the studies were screened using Rayyan Ai software. After full-text screening, randomized controlled trials that met the inclusion criteria were included.

RESULTS

Five randomized controlled trials involving 616 participants were included. The systematic review suggests strong evidence that exercise-based prehabilitation improved functional capacity and moderate evidence that it reduced postoperative complications and length of hospital stay. Although there was conflicting evidence regarding the effects of exercise-based prehabilitation on quality of life, there was limited evidence of its effects on physical activity, anxiety, depression, self-efficacy, frailty, and endothelial function.

CONCLUSIONS

Exercise-based prehabilitation can be recommended for improvements in functional capacity, postoperative complications, and length of hospital stay in patients undergoing CABG.

Exploring Information Needs and Educational Preferences of Individuals Referred to Cardiac Rehabilitation Before Program Start

PURPOSE

To explore information needs and educational preferences of individuals referred to cardiac rehabilitation (CR) before program start.

METHODS

This cross-sectional study was conducted from June 2023 to February 2024. Referred patients were contacted via email, which included a link to a website providing information about the CR program, and instructional videos. Data were collected through surveys that assessed health literacy levels, information needs (using the short version of the Information Needs in CR), frequently asked questions, delivery preferences, and engagement/satisfaction with educational resources.

RESULTS

Throughout the study period, the CR center received 2571 referrals, of which 881 individuals were eligible for the study, and 467 (mean age 66.4 ± 12.2 years; 36% women) consented and completed questionnaires. Information needs were highest for CR and diagnosis/treatment and lowest for nutrition and risk factors. The study revealed significant differences in the perceived importance of information needs across various sociodemographic and clinical characteristics, including age ( P = .01), educational level ( P = .009), work status ( P = .04), main reason for CR referral ( P < .001), and health literacy ( P = .02). Moreover, participants identified key areas of interest and concern related to their CR journey. These included inquiries about safe exercise initiation, pre-stress test instructions, and personalized exercise plans, among others. It was also observed that the majority of participants engaged with the educational materials provided and indicated high levels of satisfaction.

CONCLUSION

This study revealed patient preferences regarding educational content, delivery format, and areas of interest/concern related to CR prior to program start, providing valuable insights for improving the delivery and effectiveness of such programs.

Rehabilitation exercise quality assessment through supervised contrastive learning with hard and soft negatives

Exercise-based rehabilitation programs have proven to be effective in enhancing the quality of life and reducing mortality and rehospitalization rates. AI-driven virtual rehabilitation, which allows patients to independently complete exercises at home, utilizes AI algorithms to analyze exercise data, providing feedback to patients and updating clinicians on their progress. These programs commonly prescribe a variety of exercise types, leading to a distinct challenge in rehabilitation exercise assessment datasets: while abundant in overall training samples, these datasets often have a limited number of samples for each individual exercise type. This disparity hampers the ability of existing approaches to train generalizable models with such a small sample size per exercise type. Addressing this issue, this paper introduces a novel supervised contrastive learning framework with hard and soft negative samples that effectively utilizes the entire dataset to train a single model applicable to all exercise types. This model, with a Spatial-Temporal Graph Convolutional Network (ST-GCN) architecture, demonstrated enhanced generalizability across exercises and a decrease in overall complexity. Through extensive experiments on three publicly available rehabilitation exercise assessment datasets, UI-PRMD, IRDS, and KIMORE, our method has proven to surpass existing methods, setting a new benchmark in rehabilitation exercise quality assessment.

Comparative effectiveness of different interventions on adherence to exercise-based CR among patients after percutaneous coronary intervention: a network meta-analysis of randomized controlled trials

BACKGROUND

Exercise-based phase II cardiac rehabilitation is critical for post-PCI patients, but adherence to exercise-based phase II cardiac rehabilitation remains low. Many studies aimed at improving adherence have been conducted in recent years, but the most effective interventions remain unclear. Hence, the objective of this study was to evaluate the effectiveness and ranks of various interventions in enhancing adherence to exercise-based phase II cardiac rehabilitation for post-PCI patients.

METHODS

A network meta-analysis employing random effects was utilized to evaluate the effectiveness of different interventions. Bias evaluation was performed via the revised Cochrane risk of bias tool, with data analysis performed using STATA v15.0. The surface under the cumulative ranking was used to estimate the rankings among different interventions.

RESULTS

In the final analysis, 30 RCTs with 4267 patients across 17 different interventions were included. The results showed that patients who received home-based cardiac rehabilitation combined with mobile health intervention had the best adherence to exercise-based phase II cardiac rehabilitation (83.8%), followed by hospital-based cardiac rehabilitation combined with mobile health intervention (79.9%).

CONCLUSIONS

This network meta-analysis identified home-based CR + mobile health intervention and hospital-based CR + mobile health intervention as the top two ranked interventions for improving adherence to exercise-based phase II CR in post-PCI patients. Healthcare providers may consider prioritizing the use of home-based cardiac rehabilitation combined with mobile health intervention in clinical practice, but still need to evaluate factors such as patient preference and Medicare reimbursement availability to develop customized interventions that are not only safe and effective but also satisfying to the patient.

Reducing dropout rates in cardiac rehabilitation among cardiac patients in a vulnerable situation: systematic development and feasibility testing of the Heart Priority Programme

BACKGROUND

Despite advancements in reducing cardiovascular disease, it remains a major health concern. Cardiac rehabilitation (CR) has a positive impact on morbidity, mortality, and functioning, but faces high dropout rates especially among vulnerable patients, due to social inequalities and insufficiently tailored interventions. To address this, we developed the Heart Priority Programme targeting and supporting cardiac patients at risk of dropout. This study outlines the development of the Heart Priority Programme and share findings from a feasibility test.

METHODS

An iterative three-stage process involving cardiac patients and healthcare professionals from three community healthcare services, guided the development of the programme. Stage 1 included reviewing evidence, consulting stakeholders, and observing practice. In stage 2, a project-group of researchers and healthcare professionals was established to co-produce the programme. Stage 3 included field-testing and local adaptions. Subsequently, the programme was feasibility tested in a single-arm follow-up study across two community healthcare services. Over six months, process data on implementation, acceptability, and mechanism of impact were gathered.

RESULTS

The Heart Priority Programme was development from January 2023 to June 2023, comprising two main parts: 1) an evidence-based identification form with 13 risk factors to identify patients at risk of dropout (referred to as priority patients), and 2) an add-on intervention targeted these patients with three core elements-assigning a contact person, systematic communication, and follow-up. During a six-month feasibility phase, 260 patients were included. Of these, 91 (35%) were identified as priority patients. CR teams found that the programme was relevant, easy to integrate into daily workflow, and applicable in practice. Patient consultations yielded positive feedback on the three core elements of the add-on intervention.

CONCLUSIONS

This paper outlines the development and feasibility test of the Heart Priority Programme, co-produced to identify, and support priority patients. The programme, developed through a three-stage iterative co-production process, was found relevant and easy to implement in community healthcare services. CR teams valued its structured approach to supporting priority patients, and patients found it aligned with their needs. Although initial results are promising, further research is needed to evaluate the programme's effectiveness and suitability for widespread implementation.

TRIAL REGISTRATION

ClinicalTrials.gov NCT06575764, registered retrospectively on 28 August 2024.

Retrospective Comparison of Outcomes and Cost of Virtual Versus Center-Based Cardiac Rehabilitation Programs

BACKGROUND

Despite robust evidence supporting an association with improved outcomes in eligible patients, cardiac rehabilitation (CR) remains underused, with a minority of eligible patients participating. Virtual cardiac rehabilitation (VCR) has been proposed as an alternative to traditional center-based CR (CBCR) to improve usage rates. However, data supporting the efficacy and cost-effectiveness of VCR are limited. In the present study, we compared the outcomes and cost of a VCR versus traditional CBCR program.

METHODS AND RESULTS

In a retrospective cohort study comparing VCR versus CBCR, CBCR data were collected from a period of January 2018 to September 2023. VCR data were collected from program initiation in July 2021 to September 2023. Primary health outcomes measured were 1-year mortality rates, recurrent myocardial infarction, all-cause hospital readmission, and emergency department visits. Primary cost outcomes were analyzed as cost ratios related to VCR versus CBCR assessing total medical costs allowed, pharmacy costs, and total costs of care over the 12 months post-CR enrollment. VCR was associated with a significant reduction in 1-year all-cause hospital readmission (incident rate ratio [IRR], 0.616 [95% CI, 0.489-0.777], P<0.001) and ED admission (IRR, 0.557 [95% CI, 0.452-0.687], P<0.001) at 1 year. The IRR of myocardial infarction and all-cause mortality did not significantly differ between VCR and CBCR. In addition, VCR was associated with significant reductions in medically related (cost ratio, 0.814 [95% CI, 0.690-0.960], P=0.0144) and total costs allowed (cost ratio, 0.838 [95% CI, 0.725-0.970], P=0.0176).

CONCLUSIONS

VCR is a viable alternative to CBCR with at least comparable efficacy and cost, and as such, represents a key mechanism for improving access to and participation in CR for eligible patients.

Saving Legs & Lives: the efficacy of a community-based cardiovascular rehabilitation programme versus usual care on exercise capacity and quality of life in patients who have undergone lower limb revascularisation for peripheral arterial disease-protocol for a single-centre randomised-controlled trial

INTRODUCTION

Peripheral artery disease (PAD) is an atherosclerotic condition characterised by stenosis or occlusion of the arteries in the lower limbs. Patients with PAD commonly report intermittent claudication (leg pain/discomfort) during physical activities, which significantly limits the ability to walk and perform activities of daily living. Supervised exercise training is an effective therapy that can improve walking capacity in people with PAD. Emerging evidence also suggests that supervised exercise therapy following lower limb revascularisation can further enhance walking capacity when compared with revascularisation alone. However, access to dedicated exercise programmes for patients with PAD is limited in most countries, and there is a need to test the efficacy of alternative rehabilitation strategies and referral pathways. This randomised-controlled study aims to assess the efficacy of a cardiovascular rehabilitation (CR) programme versus usual care on walking capacity and quality of life in patients who have undergone lower limb revascularisation for PAD.

METHODS AND ANALYSIS

This will be a single-centre, prospective, parallel group, randomised-controlled trial. Sixty-six participants who have undergone a lower limb revascularisation procedure for PAD, in the previous 12 months, will be randomly allocated to a CR programme or a usual care (control) group. The CR programme will include two supervised exercise sessions per week for 6 weeks primarily consisting of intermittent treadmill walking at a moderate exercise intensity and home-based walking advice. During the 6-week programme, participants will also attend one education seminar (5.5 hours) which will cover topics such as diet, medications, exercise training and lifestyle modifications for the management of cardiovascular diseases. The control group will receive usual care and medical advice from their local doctor and vascular surgeon. The primary outcome will be 6-min walk distance. Secondary outcomes include pain-free walking distance during the six-minute walk test, maximal and pain-free walking time during a graded treadmill walking test, cardiorespiratory fitness, self-reported walking capacity, disease-specific quality of life, and self-reported and objectively measured physical activity levels. Exploratory outcomes include brachial artery flow-mediated dilation, arterial stiffness, ankle-brachial blood pressure index and biomarkers of cardiovascular disease risk. Outcomes will be assessed at baseline (week 1), following the CR/usual care period (week 8) and again at 6-month follow-up (week 34).

ETHICS AND DISSEMINATION

This study has received ethics approval from the Human Research Ethics Committees of Queensland Health Metro North Hospital and Health Service (94155) and the University of the Sunshine Coast (S231914). Findings from this study will be disseminated in peer-reviewed journals and through national and international conference presentations.

TRIAL REGISTRATION NUMBER

ACTRN12623000190606.

Exercise training attenuates cardiac dysfunction induced by excessive sympathetic activation through an AMPK-KLF4-FMO2 axis

Cardiovascular diseases (CVDs) are a leading cause of mortality worldwide and are associated with an overactivated sympathetic system. Although exercise training has shown promise in mitigating sympathetic stress-induced cardiac remodeling, the precise mechanisms remain elusive. Here, we demonstrate that exercise significantly upregulates cardiac flavin-containing monooxygenase 2 (FMO2) expression. Notably, we find that exercise training effectively counteracts sympathetic overactivation-induced cardiac dysfunction and fibrosis by enhancing FMO2 expression via adenosine 5'-monophosphate (AMP)-activated protein kinase (AMPK) activation. Functional investigations employing FMO2 knockdown with adeno-associated virus 9 (AAV9) underscore the necessity for FMO2 expression to protect the heart during exercise in vivo. Furthermore, we identify the krüppel-like factor 4 (KLF4) as a transcriptional mediator of FMO2 that is crucial for the mechanism through which AMPK activation protects against sympathetic overactivation-induced cardiac dysfunction and fibrosis. Taken together, our study reveals a cardioprotective mechanism for exercise training through an AMPK-KLF4-FMO2 signaling pathway that underscores how exercise alleviates cardiac dysfunction induced by excessive sympathetic activation.

Exercise training and chronic kidney disease: characterization and bibliometrics of citation classics of clinical intervention trials

BACKGROUND

Exercise research targeting chronic kidney disease (CKD) has been conducted for more than 30 years, and the benefits of exercise for CKD patients have been progressively demonstrated. This study analyzes citation classics on clinical intervention trials on exercise training and CKD to describe the research landscape and hotspots through bibliometric analysis.

METHODS

To identify clinical trials of exercise training interventions for CKD with more than 100 citations from the Web of Science Core Collection database. Extracted bibliometric information, participant information, and study characteristics of the included articles. The total citations, annual average citations, publication of year, author keywords, and study-related data were bibliometric analyzed and described using Excel 2019 and VOSviewer software.

RESULTS

A total of 30 citation classics were included, with a total citation frequency of 102 to 279 (mean ± standard deviation: 148.4 ± 49.4). The American Journal of Kidney Diseases (n = 7) published the most (n = 7) classic citations in the field of CKD exercise research, and the Journal of the American Society of Nephrology was the most cited. The hotspot of research around CKD and exercise training interventions focused on population (hemodialysis and end-stage renal disease), exercise type (resistance training, yoga, and leg-cycling), and outcomes (cardiovascular indices, physical performance, psychological status, kidney function, physical activity). Reported dropout rates ranged from 0.0% to 47.4%.

CONCLUSION

A bibliometric analysis of citation classics on exercise training and CKD highlights the potential benefits of exercise as a non-pharmacological therapy for patients with CKD, as well as developments and hotspots in the field.