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Ishihara K, Izawa KP, Kitamura M, Kanejima Y, Ogawa M, Yoshihara R, Morisawa T, Shimizu I. Effects of cardiac rehabilitation on cognitive function in patients with acute coronary syndrome: A systematic review. Heliyon 2024; 10:e32890. [PMID: 38975067 PMCID: PMC11226889 DOI: 10.1016/j.heliyon.2024.e32890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 06/07/2024] [Accepted: 06/11/2024] [Indexed: 07/09/2024] Open
Abstract
Background Construction of an intervention method for the cognitive dysfunction of patients with acute coronary syndrome (ACS) is needed. Exercise-based comprehensive cardiac rehabilitation is a potentially effective approach that can improve cognitive function in ACS patients. This study aimed to investigate the effect of cardiac rehabilitation on cognitive function in ACS patients through a systematic review. Methods A systematic review was conducted of studies on PubMed, MEDLINE, Web of Science, and the Cumulative Index to Nursing and Allied Health Literature (CINAHL) on September 13, 2022, to identify those reporting the effects of cardiac rehabilitation on cognitive function in ACS patients. Data that reported exercise-based comprehensive cardiac rehabilitation and cognitive function (even if not main results and any type of cognitive function assessment was used) were extracted. Results In total, six studies were included that comprised a total of 1085 ACS patients. Overall positive effects of cardiac rehabilitation on cognitive function in ACS patients were reported across the six studies. All studies included aerobic exercise, resistance exercise, and patient education in cardiac rehabilitation. Meta-analysis could not be undertaken because each dataset used different methods to evaluate cognitive function, and the outcomes were different. Conclusions This systematic review showed that cardiac rehabilitation could have positive effects on cognitive function in ACS patients. Our results support the efficacy of cardiac rehabilitation for cognitive function in ACS patients. Additional well-designed clinical trials of exercise-based comprehensive cardiac rehabilitation should be conducted to clarify the true effect on cognitive function in ACS patients.
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Affiliation(s)
- Kodai Ishihara
- Department of Physical Therapy, Faculty of Nursing and Rehabilitation, Konan Women's University, 2-23 Morikitamachi 6-chome, Higashinada-ku, Kobe, 658-0001, Japan
- Department of Public Health, Graduate School of Health Sciences, Kobe University, 10-2 Tomogaoka 7-chome, Suma-ku, Kobe, 654-0142, Japan
- Cardiovascular Stroke Renal Project (CRP), Japan
| | - Kazuhiro P. Izawa
- Department of Public Health, Graduate School of Health Sciences, Kobe University, 10-2 Tomogaoka 7-chome, Suma-ku, Kobe, 654-0142, Japan
- Cardiovascular Stroke Renal Project (CRP), Japan
| | - Masahiro Kitamura
- Department of Public Health, Graduate School of Health Sciences, Kobe University, 10-2 Tomogaoka 7-chome, Suma-ku, Kobe, 654-0142, Japan
- Cardiovascular Stroke Renal Project (CRP), Japan
- School of Physical Therapy, Faculty of Rehabilitation, Reiwa Health Sciences University, 1-12 Wajirogaoka 2-chome, Higashi-ku, Fukuoka, 811-0213, Japan
| | - Yuji Kanejima
- Department of Public Health, Graduate School of Health Sciences, Kobe University, 10-2 Tomogaoka 7-chome, Suma-ku, Kobe, 654-0142, Japan
- Cardiovascular Stroke Renal Project (CRP), Japan
- Department of Rehabilitation, Kobe City Medical Center General Hospital, 1-1 Minatojimaminamicho 2-chome, Chuo-ku, Kobe, 650-0047, Japan
| | - Masato Ogawa
- Department of Public Health, Graduate School of Health Sciences, Kobe University, 10-2 Tomogaoka 7-chome, Suma-ku, Kobe, 654-0142, Japan
- Cardiovascular Stroke Renal Project (CRP), Japan
- Department of Rehabilitation, Faculty of Health Sciences, Osaka Health Sciences University, 9-27 Temma 1-chome, Kita-ku, Osaka, 530-0043, Japan
| | - Ryo Yoshihara
- Department of Public Health, Graduate School of Health Sciences, Kobe University, 10-2 Tomogaoka 7-chome, Suma-ku, Kobe, 654-0142, Japan
- Cardiovascular Stroke Renal Project (CRP), Japan
- Department of Rehabilitation, Kobe City Medical Center General Hospital, 1-1 Minatojimaminamicho 2-chome, Chuo-ku, Kobe, 650-0047, Japan
| | - Tomoyuki Morisawa
- Department of Physical Therapy, Faculty of Health Sciences, Juntendo University, 2-12 Hongo 3-chome, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Ikki Shimizu
- Department of Diabetes, Sakakibara Heart Institute of Okayama, 5-1 Nakaicho 2-chome, Kita-ku, Okayama, 700-0804, Japan
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Kanaoka K, Nishida T, Iwanaga Y, Nakai M, Tonegawa-Kuji R, Nishioka Y, Myojin T, Okada K, Noda T, Kusano K, Miyamoto Y, Saito Y, Imamura T. Oral anticoagulation after atrial fibrillation catheter ablation: benefits and risks. Eur Heart J 2024; 45:522-534. [PMID: 38117227 PMCID: PMC10873714 DOI: 10.1093/eurheartj/ehad798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 10/20/2023] [Accepted: 11/20/2023] [Indexed: 12/21/2023] Open
Abstract
BACKGROUND AND AIMS Few recent large-scale studies have evaluated the risks and benefits of continuing oral anticoagulant (OAC) therapy after catheter ablation (CA) for atrial fibrillation (AF). This study evaluated the status of continuation of OAC therapy and the association between continuation of OAC therapy and thromboembolic and bleeding events according to the CHADS2 score. METHODS This retrospective study included data from the Japanese nationwide administrative claims database of patients who underwent CA for AF between April 2014 and March 2021. Patients without AF recurrence assessed by administrative data of the treatment modalities were divided into two groups according to continuation of OAC therapy 6 months after the index CA. The primary outcomes were thromboembolism and major bleeding after a landmark period of 6 months. After inverse probability of treatment weighting analysis, the association between OAC continuation and outcomes was determined according to the CHADS2 score. RESULTS Among 231 374 patients included, 69.7%, 21.6%, and 8.7% had CHADS2 scores of ≤1, 2, and ≥3, respectively. Of these, 71% continued OAC therapy at 6 months. The OAC continuation rate was higher in the high CHADS2 score group than that in the low CHADS2 score group. Among all patients, 2451 patients (0.55 per 100 person-years) had thromboembolism and 2367 (0.53 per 100 person-years) had major bleeding. In the CHADS2 score ≤1 group, the hazard ratio of the continued OAC group was 0.86 [95% confidence interval (CI): 0.74-1.01, P = .06] for thromboembolism and was 1.51 (95% CI: 1.27-1.80, P < .001) for major bleeding. In the CHADS2 score ≥3 group, the hazard ratio of the continued OAC group was 0.61 (95% CI: 0.46-0.82, P = .001) for thromboembolism and was 1.05 (95% CI: 0.71-1.56, P = 0.81) for major bleeding. CONCLUSIONS This observational study suggests that the benefits and risks of continuing OAC therapy after CA for AF differ based on the patient's CHADS2 score. The risk of major bleeding due to OAC continuation seems to outweigh the risk reduction of thromboembolism in patients with lower thromboembolic risk.
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Affiliation(s)
- Koshiro Kanaoka
- Department of Medical and Health Information Management, National Cerebral and Cardiovascular Center, Kishibe-Shimmachi 6-1, Suita, Osaka 564-8565, Japan
- Department of Cardiovascular Medicine, Nara Medical University, Kashihara, Nara, Japan
| | - Taku Nishida
- Department of Cardiovascular Medicine, Nara Medical University, Kashihara, Nara, Japan
| | - Yoshitaka Iwanaga
- Department of Medical and Health Information Management, National Cerebral and Cardiovascular Center, Kishibe-Shimmachi 6-1, Suita, Osaka 564-8565, Japan
- Department of Cardiology, Sakurabashi-Watanabe Hospital, Umeda 2-4-32, Osaka, Osaka 530-0001, Japan
| | - Michikazu Nakai
- Department of Medical and Health Information Management, National Cerebral and Cardiovascular Center, Kishibe-Shimmachi 6-1, Suita, Osaka 564-8565, Japan
| | - Reina Tonegawa-Kuji
- Department of Medical and Health Information Management, National Cerebral and Cardiovascular Center, Kishibe-Shimmachi 6-1, Suita, Osaka 564-8565, Japan
| | - Yuichi Nishioka
- Department of Public Health, Health Management and Policy, Nara Medical University, Kashihara, Nara, Japan
| | - Tomoya Myojin
- Department of Public Health, Health Management and Policy, Nara Medical University, Kashihara, Nara, Japan
| | - Katsuki Okada
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
- Department of Medical Informatics, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Tatsuya Noda
- Department of Public Health, Health Management and Policy, Nara Medical University, Kashihara, Nara, Japan
| | - Kengo Kusano
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Yoshihiro Miyamoto
- Open Innovation Center, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Yoshihiko Saito
- Department of Cardiovascular Medicine, Nara Medical University, Kashihara, Nara, Japan
- Nara Prefecture Seiwa Medical Center, Sango, Nara, Japan
| | - Tomoaki Imamura
- Department of Public Health, Health Management and Policy, Nara Medical University, Kashihara, Nara, Japan
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Kanaoka K, Iwanaga Y, Okada K, Terasaki S, Nishioka Y, Nakai M, Kamon D, Myojin T, Soeda T, Noda T, Horii M, Sakata Y, Miyamoto Y, Saito Y, Imamura T. Validity of Diagnostic Algorithms for Cardiovascular Diseases in Japanese Health Insurance Claims. Circ J 2023; 87:536-542. [PMID: 36709984 DOI: 10.1253/circj.cj-22-0566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND We aimed to validate a claims-based diagnostic algorithm to identify hospitalized patients with acute major cardiovascular diseases (CVDs) from health insurance claims in Japan. METHODS AND RESULTS This retrospective multicenter validation study was conducted at 4 institutes, including Japanese Circulation Society-certified and uncertified hospitals in Japan. Data on patients with CVDs in departmental lists or with International Classification of Diseases, 10th Revision (ICD-10) codes for CVDs hospitalized between April 2018 and March 2019 were extracted. We examined the sensitivity and positive predictive value of a diagnostic algorithm using ICD-10 codes, medical examinations, and treatments for acute coronary syndrome (ACS), acute heart failure (HF), and acute aortic disease (AAD). We identified 409 patients with ACS (mean age 70.6 years; 24.7% female), 615 patients with acute HF (mean age 77.3 years; 46.2% female), and 122 patients with AAD (mean age 73.4 years; 36.1% female). The respective sensitivity and positive predictive value for the algorithm were 0.86 (95% confidence interval [CI] 0.82-0.89) and 0.95 (95% CI 0.92-0.97) for ACS; 0.74 (95% CI 0.70-0.77) and 0.79 (95% CI 0.76-0.83) for acute HF; and 0.86 (95% CI 0.79-0.92) and 0.83 (95% CI 0.76-0.89) for AAD. CONCLUSIONS The validity of the diagnostic algorithm for Japanese claims data was acceptable. Our results serve as a foundation for future studies on CVDs using nationwide administrative data.
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Affiliation(s)
- Koshiro Kanaoka
- Department of Medical and Health Information Management, National Cerebral and Cardiovascular Center
- Department of Cardiovascular Medicine, Nara Medical University
| | - Yoshitaka Iwanaga
- Department of Medical and Health Information Management, National Cerebral and Cardiovascular Center
| | - Katsuki Okada
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine
- Department of Transformative System for Medical Information, Osaka University Graduate School of Medicine
| | | | - Yuichi Nishioka
- Department of Public Health, Health Management and Policy, Nara Medical University
| | - Michikazu Nakai
- Department of Medical and Health Information Management, National Cerebral and Cardiovascular Center
| | - Daisuke Kamon
- Department of Cardiovascular Medicine, Nara Medical University
| | - Tomoya Myojin
- Department of Public Health, Health Management and Policy, Nara Medical University
| | - Tsunenari Soeda
- Department of Cardiovascular Medicine, Nara Medical University
| | - Tatsuya Noda
- Department of Public Health, Health Management and Policy, Nara Medical University
| | - Manabu Horii
- Department of Cardiovascular Medicine, Nara City Hospital
| | - Yasushi Sakata
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine
| | | | - Yoshihiko Saito
- Department of Cardiovascular Medicine, Nara Medical University
| | - Tomoaki Imamura
- Department of Public Health, Health Management and Policy, Nara Medical University
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Tonegawa-Kuji R, Kanaoka K, Iwanaga Y. Current status of real-world big data research in the cardiovascular field in Japan. J Cardiol 2023; 81:307-315. [PMID: 36126909 DOI: 10.1016/j.jjcc.2022.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 09/02/2022] [Indexed: 02/01/2023]
Abstract
Real-world data (RWD) are observational data obtained by collecting, structuring, and accumulating patient information among the medical big data. RWD are derived from a variety of patient medical care and health information outside of conventional research data, and include electronic health records, claims data, registry data of disease, drug and device, health check-up data, and more recently, patient information data from wearable devices. They are currently being utilized in various forms for optimal medical care and real-world evidence (RWE) is constructed through a process of hypothesis generation and verification based on the RWD research. Together with classic clinical research and pragmatic trials, RWE shapes the learning healthcare system and contributes to the improvement of medical care. In the cardiovascular medical care of the current super-aged society, the need for a variety of RWE and the research is increasing, since the guidelines established over time and the medical care based on it cannot necessarily be the best in accordance with the current medical situation. In this review, we focus on the RWD and RWE studies in the cardiovascular medical field and outlines their current status in Japan. Furthermore, we discuss the potential for extending the studies and issues related to the use of medical big data and RWD.
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Affiliation(s)
- Reina Tonegawa-Kuji
- Department of Medical and Health Information Management, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Koshiro Kanaoka
- Department of Medical and Health Information Management, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Yoshitaka Iwanaga
- Department of Medical and Health Information Management, National Cerebral and Cardiovascular Center, Suita, Japan.
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Quality of Coronary Care: Reducing Practice Variability. Can J Cardiol 2023; 39:524-526. [PMID: 36681382 DOI: 10.1016/j.cjca.2023.01.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 01/16/2023] [Indexed: 01/20/2023] Open
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Kanaoka K, Iwanaga Y, Nakai M, Nishioka Y, Myojin T, Kubo S, Okada K, Noda T, Sakata Y, Miyamoto Y, Saito Y, Imamura T. Multifactorial Effects of Outpatient Cardiac Rehabilitation in Patients with Heart Failure: A Nationwide Retrospective Cohort Study. Eur J Prev Cardiol 2022; 30:zwac274. [PMID: 36378557 DOI: 10.1093/eurjpc/zwac274] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 11/10/2022] [Accepted: 11/14/2022] [Indexed: 11/16/2022]
Abstract
AIM Although cardiac rehabilitation (CR) is a strongly recommended therapy, no large study has assessed the effects of outpatient CR in patients with heart failure (HF) in real-world settings. Therefore, this study aimed to investigate the multifactorial effects of outpatient CR in patients with HF using a nationwide database. METHODS AND RESULTS This nationwide retrospective cohort study was performed using the National Database of Health Insurance Claims and Specific Health Checkups of Japan. Patients with acute HF who underwent inpatient CR between April 2014 and March 2020 were included. The association between outpatient CR participation and all-cause mortality, rehospitalisation for HF, use of medical resources, and medical costs was analysed using propensity score matching analysis. Of 250,528 patients, 17,884 (7.1%) underwent outpatient CR. After propensity score matching, the CR (+) group was associated with a reduction in the risk of all-cause mortality (hazard ratio [HR]: 0.64, 95% confidence interval [CI]: 0.60-0.68, p < 0.001) and rehospitalisation for HF compared to the CR (-) group (HR: 0.87, 95% CI: 0.82-0.92, p < 0.001). The proportion of guideline-based medication use for HF at 1 year was higher in the CR (+) group than in the CR (-) group. The total medical costs from the index hospitalisation to 1.5 years after admission were similar between the groups. CONCLUSION Outpatient CR participation after discharge from HF was associated with reduced mortality and rehospitalisation for HF without increasing medical costs.
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Affiliation(s)
- Koshiro Kanaoka
- Department of Medical and Health Information Management, National Cerebral and Cardiovascular Center
- Department of Cardiovascular Medicine, Nara Medical University
| | - Yoshitaka Iwanaga
- Department of Medical and Health Information Management, National Cerebral and Cardiovascular Center
| | - Michikazu Nakai
- Department of Medical and Health Information Management, National Cerebral and Cardiovascular Center
- Department of Biostatistics, National Cerebral and Cardiovascular Center
| | - Yuichi Nishioka
- Department of Public Health, Health Management and Policy, Nara Medical University
| | - Tomoya Myojin
- Department of Public Health, Health Management and Policy, Nara Medical University
| | - Shinichiro Kubo
- Department of Public Health, Health Management and Policy, Nara Medical University
| | - Katsuki Okada
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine
- Department of Medical Informatics, Osaka University Graduate School of Medicine
| | - Tatsuya Noda
- Department of Public Health, Health Management and Policy, Nara Medical University
| | - Yasushi Sakata
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine
| | | | - Yoshihiko Saito
- Department of Cardiovascular Medicine, Nara Medical University
- Nara Prefecture Seiwa Medical Center
| | - Tomoaki Imamura
- Department of Public Health, Health Management and Policy, Nara Medical University
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