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Hiruma T, Nakayama A, Sakamoto J, Hori K, Nanasato M, Hosoda T, Isobe M. Comprehensive Cardiac Rehabilitation Following Acute Myocardial Infarction Improves Clinical Outcomes Regardless of Exercise Capacity. Circ J 2024; 88:982-992. [PMID: 38631882 DOI: 10.1253/circj.cj-23-0668] [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: 04/19/2024]
Abstract
BACKGROUND Reduced exercise capacity is a prognostic indicator of adverse outcomes in patients with acute myocardial infarction (AMI). However, few studies have evaluated the effectiveness of comprehensive cardiac rehabilitation (CR) in this population. This study aimed to clarify the efficacy of comprehensive CR in patients with AMI and reduced exercise capacity.Methods and Results: This cohort study included 610 patients with AMI who underwent percutaneous coronary intervention. Major adverse cardiovascular events (MACE) were compared between patients who participated in comprehensive outpatient CR for 150 days (CR group; n=430) and those who did not (non-CR group; n=180). During the mean (±SD) follow-up period of 6.1±4.0 years, the CR group exhibited a lower incidence of MACE (log-rank P=0.002). Multivariable analysis revealed that Killip classification, diuretics at discharge, and participation in comprehensive CR were independently associated with MACE. The CR group was further divided into 2 groups, namely reduced exercise capacity (% predicted peak V̇O2<80%; n=241) and preserved exercise capacity (≥80%; n=147), based on the initial cardiopulmonary exercise test. Despite distinct exercise capacities, the incidence of MACE was comparable and physical parameters improved similarly after comprehensive CR in both groups. CONCLUSIONS Comprehensive CR in patients with AMI effectively reduced the incidence of MACE regardless of initial exercise capacity. Cardiologists should actively encourage patients with low exercise capacity to participate in comprehensive CR.
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Affiliation(s)
- Takashi Hiruma
- Department of Cardiology, Sakakibara Heart Institute
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo
| | - Atsuko Nakayama
- Department of Cardiology, Sakakibara Heart Institute
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo
| | - Junko Sakamoto
- Department of Rehabilitation, Sakakibara Heart Institute
| | - Kentaro Hori
- Department of Rehabilitation, Sakakibara Heart Institute
| | | | - Toru Hosoda
- Department of Cardiology, Sakakibara Heart Institute
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Qian Y, Wang X, Cai L, Han J, Huang Z, Lou Y, Zhang B, Wang Y, Sun X, Zhang Y, Zhu A. Model informed precision medicine of Chinese herbal medicines formulas-A multi-scale mechanistic intelligent model. J Pharm Anal 2024; 14:100914. [PMID: 38694562 PMCID: PMC11061219 DOI: 10.1016/j.jpha.2023.12.004] [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: 08/20/2023] [Revised: 11/21/2023] [Accepted: 12/07/2023] [Indexed: 05/04/2024] Open
Abstract
Recent trends suggest that Chinese herbal medicine formulas (CHM formulas) are promising treatments for complex diseases. To characterize the precise syndromes, precise diseases and precise targets of the precise targets between complex diseases and CHM formulas, we developed an artificial intelligence-based quantitative predictive algorithm (DeepTCM). DeepTCM has gone through multilevel model calibration and validation against a comprehensive set of herb and disease data so that it accurately captures the complex cellular signaling, molecular and theoretical levels of traditional Chinese medicine (TCM). As an example, our model simulated the optimal CHM formulas for the treatment of coronary heart disease (CHD) with depression, and through model sensitivity analysis, we calculated the balanced scoring of the formulas. Furthermore, we constructed a biological knowledge graph representing interactions by associating herb-target and gene-disease interactions. Finally, we experimentally confirmed the therapeutic effect and pharmacological mechanism of a novel model-predicted intervention in humans and mice. This novel multiscale model opened up a new avenue to combine "disease syndrome" and "macro micro" system modeling to facilitate translational research in CHM formulas.
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Affiliation(s)
- Yuanyuan Qian
- Zhejiang Key Laboratory of Blood-Stasis-Toxin Syndrome, Zhejiang Chinese Medical University, Hangzhou, 310000, China
- Zhejiang Engineering Research Center for “Preventive Treatment” Smart Health of Traditional Chinese Medicine, Zhejiang Chinese Medical University, Hangzhou, 310000, China
- College of Basic Medical Sciences, Zhejiang Chinese Medical University, Hangzhou, 310000, China
| | - Xiting Wang
- Academy of Mathematics and Systems Science, Chinese Academy of Sciences, Beijing, 100190, China
| | - Lulu Cai
- Zhejiang Key Laboratory of Blood-Stasis-Toxin Syndrome, Zhejiang Chinese Medical University, Hangzhou, 310000, China
- Zhejiang Engineering Research Center for “Preventive Treatment” Smart Health of Traditional Chinese Medicine, Zhejiang Chinese Medical University, Hangzhou, 310000, China
- College of Basic Medical Sciences, Zhejiang Chinese Medical University, Hangzhou, 310000, China
- Academy of Chinese Medical Science, Zhejiang Chinese Medical University, Hangzhou, 310000, China
| | - Jiangxue Han
- Zhejiang Key Laboratory of Blood-Stasis-Toxin Syndrome, Zhejiang Chinese Medical University, Hangzhou, 310000, China
- Zhejiang Engineering Research Center for “Preventive Treatment” Smart Health of Traditional Chinese Medicine, Zhejiang Chinese Medical University, Hangzhou, 310000, China
- College of Basic Medical Sciences, Zhejiang Chinese Medical University, Hangzhou, 310000, China
- Academy of Chinese Medical Science, Zhejiang Chinese Medical University, Hangzhou, 310000, China
| | - Zhu Huang
- Zhejiang Key Laboratory of Blood-Stasis-Toxin Syndrome, Zhejiang Chinese Medical University, Hangzhou, 310000, China
- Zhejiang Engineering Research Center for “Preventive Treatment” Smart Health of Traditional Chinese Medicine, Zhejiang Chinese Medical University, Hangzhou, 310000, China
- College of Basic Medical Sciences, Zhejiang Chinese Medical University, Hangzhou, 310000, China
| | - Yahui Lou
- Zhejiang Key Laboratory of Blood-Stasis-Toxin Syndrome, Zhejiang Chinese Medical University, Hangzhou, 310000, China
- Zhejiang Engineering Research Center for “Preventive Treatment” Smart Health of Traditional Chinese Medicine, Zhejiang Chinese Medical University, Hangzhou, 310000, China
- College of Basic Medical Sciences, Zhejiang Chinese Medical University, Hangzhou, 310000, China
| | - Bingyue Zhang
- Zhejiang Key Laboratory of Blood-Stasis-Toxin Syndrome, Zhejiang Chinese Medical University, Hangzhou, 310000, China
- Zhejiang Engineering Research Center for “Preventive Treatment” Smart Health of Traditional Chinese Medicine, Zhejiang Chinese Medical University, Hangzhou, 310000, China
- College of Basic Medical Sciences, Zhejiang Chinese Medical University, Hangzhou, 310000, China
| | - Yanjie Wang
- Zhejiang Key Laboratory of Blood-Stasis-Toxin Syndrome, Zhejiang Chinese Medical University, Hangzhou, 310000, China
- Zhejiang Engineering Research Center for “Preventive Treatment” Smart Health of Traditional Chinese Medicine, Zhejiang Chinese Medical University, Hangzhou, 310000, China
- College of Basic Medical Sciences, Zhejiang Chinese Medical University, Hangzhou, 310000, China
| | - Xiaoning Sun
- Affiliated Hospital of Liaoning University of Traditional Chinese Medicine, Shenyang, 110032, China
| | - Yan Zhang
- Affiliated Hospital of Liaoning University of Traditional Chinese Medicine, Shenyang, 110032, China
| | - Aisong Zhu
- Zhejiang Key Laboratory of Blood-Stasis-Toxin Syndrome, Zhejiang Chinese Medical University, Hangzhou, 310000, China
- Zhejiang Engineering Research Center for “Preventive Treatment” Smart Health of Traditional Chinese Medicine, Zhejiang Chinese Medical University, Hangzhou, 310000, China
- College of Basic Medical Sciences, Zhejiang Chinese Medical University, Hangzhou, 310000, China
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3
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Duscha BD, Ross LM, Hoselton AL, Piner LW, Pieper CF, Kraus WE. A Detailed Analysis of Cardiac Rehabilitation on 180-Day All-Cause Hospital Readmission and Mortality. J Cardiopulm Rehabil Prev 2024; 44:99-106. [PMID: 38113355 PMCID: PMC10913862 DOI: 10.1097/hcr.0000000000000835] [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] [Indexed: 12/21/2023]
Abstract
PURPOSE Cardiac rehabilitation (CR) is endorsed for coronary artery disease (CAD), but studies report inconsistent findings regarding efficacy. The objective of this study was to determine whether confounding factors, potentially contributing to these heterogeneous findings, impact the effect of CR on all-cause readmission and mortality. METHODS Patients (n = 2641) with CAD, CR eligible, and physically able were identified. Electronic medical records were inspected individually for each patient to extract demographic, clinical characteristic, readmission, and mortality information. Patients (n = 214) attended ≥1 CR session (CR group). Survival was considered free from: all-cause readmission; or composite outcome of all-cause readmission or death. Cox proportional hazards models, adjusting for demographics, comorbidities, and discharge criteria, were used to determine HR with 95% CI and to compare 180-d survival rates between the CR and no-CR groups. RESULTS During 180 d of follow-up, 12.1% and 18.7% of the CR and non-CR patients were readmitted to the hospital. There was one death (0.5%) in the CR group, while 98 deaths (4.0%) occurred in the non-CR group. After adjustment for age, sex, race, depression, anxiety, dyslipidemia, hypertension, obesity, smoking, type 2 diabetes, and discharge criteria, the final model revealed a significant 42.7% reduction in readmission or mortality risk for patients who attended CR (HR = 0.57: 95% CI, 0.33-0.98; P = .043). CONCLUSIONS Regardless of demographic characteristics, comorbidities, and cardiovascular discharge criteria, the risk of 180-d all-cause readmission or death was markedly decreased in patients who attended CR compared with those who did not.
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Affiliation(s)
- Brian D. Duscha
- Duke University School of Medicine, Division of Cardiology and Duke Molecular Physiology Institute, Durham, North Carolina (Messrs Duscha and Hoselton, Drs Ross and Kraus, and Ms Piner); and Center for Aging and Human Development, Duke University School of Medicine Center, Durham, and Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, North Carolina (Dr Pieper)
| | - Leanna M. Ross
- Duke University School of Medicine, Division of Cardiology and Duke Molecular Physiology Institute, Durham, North Carolina (Messrs Duscha and Hoselton, Drs Ross and Kraus, and Ms Piner); and Center for Aging and Human Development, Duke University School of Medicine Center, Durham, and Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, North Carolina (Dr Pieper)
| | - Andrew L. Hoselton
- Duke University School of Medicine, Division of Cardiology and Duke Molecular Physiology Institute, Durham, North Carolina (Messrs Duscha and Hoselton, Drs Ross and Kraus, and Ms Piner); and Center for Aging and Human Development, Duke University School of Medicine Center, Durham, and Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, North Carolina (Dr Pieper)
| | - Lucy W. Piner
- Duke University School of Medicine, Division of Cardiology and Duke Molecular Physiology Institute, Durham, North Carolina (Messrs Duscha and Hoselton, Drs Ross and Kraus, and Ms Piner); and Center for Aging and Human Development, Duke University School of Medicine Center, Durham, and Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, North Carolina (Dr Pieper)
| | - Carl F. Pieper
- Duke University School of Medicine, Division of Cardiology and Duke Molecular Physiology Institute, Durham, North Carolina (Messrs Duscha and Hoselton, Drs Ross and Kraus, and Ms Piner); and Center for Aging and Human Development, Duke University School of Medicine Center, Durham, and Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, North Carolina (Dr Pieper)
| | - William E. Kraus
- Duke University School of Medicine, Division of Cardiology and Duke Molecular Physiology Institute, Durham, North Carolina (Messrs Duscha and Hoselton, Drs Ross and Kraus, and Ms Piner); and Center for Aging and Human Development, Duke University School of Medicine Center, Durham, and Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, North Carolina (Dr Pieper)
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Lv M, Liao L, Deng Y, Jin H, Chen L, Huang Z. Risk factors for inspiratory muscle weakness in coronary heart disease. Heart Lung 2023; 60:35-38. [PMID: 36878105 DOI: 10.1016/j.hrtlng.2023.02.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 02/15/2023] [Accepted: 02/19/2023] [Indexed: 03/07/2023]
Abstract
BACKGROUND Patients with coronary heart disease (CHD) are susceptible to lung function problems caused by respiratory muscle weakness. Many CHD patients show complications of respiratory muscle weakness, but the risk factors remain unclear. OBJECTIVE To explore the risk factors for inspiratory muscle weakness in CHD. METHODS This study enrolled 249 patients with CHD who underwent maximal inspiratory pressure (MIP) measurement between April 2021 and March 2022.According to the percentage of MIP (MIP/Predicted normal value [PNV]), patients were divided into the inspiratory muscle weakness (IMW) (n = 149) (MIP/PNV<70%) and control groups (n = 100) (MIP/PNV≥70༅). Clinical information and MIP of the two groups were collected and analyzed. RESULTS The incidence of IMW was 59.8% (n = 149). Age (P < 0.001); history of heart failure (P < 0.001), hypertension (P = 0.04), and peripheral artery disease (PAD) (P = 0.001); left ventricular end-systolic dimension (P = 0.035); presence of segmental motion abnormality of the ventricular wall (P = 0.030); and high density lipoprotein cholesterol (P = 0.001) and N-terminal brain natriuretic peptide (NT-proBNP) levels (P < 0.001) in the IMW group were significantly higher than those in the control group. The proportion of anatomic complete revascularization (P = 0.009), left ventricular ejection fraction (P = 0.010), and alanine transaminase (P = 0.014) and triglycerides levels (P = 0.014) in the IMW group were significantly lower than those in the control group. Logistic regression analysis showed that anatomic complete revascularization (OR=0.350, 95%CI 0.157-0.781) and NT-proBNP level (OR=1.002, 95%CI 1.000-1.004) were independent risk factors for IMW. CONCLUSION The independent risk factors for decreased IMW in patients with CAD were anatomic incomplete revascularization and NT-proBNP level.
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Affiliation(s)
- Meifen Lv
- Department of Cardiology, the Third Affiliated Hospital of Guangzhou Medical University, China
| | - Lihua Liao
- Department of Cardiology, the Third Affiliated Hospital of Guangzhou Medical University, China
| | - Yecheng Deng
- Department of Cardiology, the Third Affiliated Hospital of Guangzhou Medical University, China
| | - Huan Jin
- Department of Clinical medicine, Guangzhou Medical University, China
| | - Linghua Chen
- Department of Cardiology, the Third Affiliated Hospital of Guangzhou Medical University, China
| | - Zhaoqi Huang
- Department of Cardiology, the Third Affiliated Hospital of Guangzhou Medical University, China.
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5
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Zhang W, Supervia M, Dun Y, Lennon RJ, Ding R, Sandhu G, Tilbury T, Squires RW, Vardar U, Tabatabaei N, Thomas RJ. The Association Between a Second Course of Cardiac Rehabilitation and Cardiovascular Outcomes Following Repeat Percutaneous Coronary Intervention Events. J Cardiopulm Rehabil Prev 2023; 43:101-108. [PMID: 35940745 DOI: 10.1097/hcr.0000000000000717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE Survivors of coronary artery disease (CAD) events are at risk for repeat events. Although evidence supports cardiac rehabilitation (CR) after an initial CAD event, it is unclear whether a repeat course of CR (CR × 2) is beneficial after a recurrent CAD event. The purpose of this study was to determine the association of CR × 2 with clinical outcomes in persons undergoing repeat percutaneous coronary intervention (PCI). METHODS We assessed the prevalence of CR × 2 and its impact on cardiovascular outcomes in individuals who experienced a repeat PCI at the Mayo Clinic hospitals between January 1, 1998, and December 31, 2013. Landmark analyses were used to calculate unadjusted and propensity score adjusted mortality rates and cardiovascular (CV) events rates for patients who underwent CR × 2 compared with those who did not. RESULTS Among 240 individuals who had a repeat PCI and who had participated in CR after their first PCI, 97 (40%) participated in CR × 2. Outcomes were assessed for a mean follow-up time of 7.8 yr (IQR 7.1-9.0 yr). Propensity score-based inverse probability weighting analysis revealed that CR × 2 was associated with significantly lower target lesion revascularization (HR = 0.47: 95% CI, 0.26-0.86; P = .014), lower combined end point of CV death, myocardial infarction, and target lesion revascularization (HR = 0.57: 95% CI, 0.36-0.89; P = .014), and lower CV hospitalization (HR = 0.60; 95% CI, 0.43-0.84; P = .003). CONCLUSION A second course of CR following repeat PCI is associated with a lower risk of adverse clinical outcomes. These findings support current policies that allow for repeat courses of CR following recurrent CV events.
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Affiliation(s)
- Wenliang Zhang
- Xiangya Hospital, Central South University, Changsha, China (Drs Zhang and Dun); Department of Physical Medicine and Rehabilitation, Gregorio Marañon General University Hospital, Gregorio Marañon Health Research Institute, Madrid, Spain (Dr Supervia); Departments of Quantitative Health Sciences (Mr Lennon) and Cardiovascular Medicine (Drs Sandhu, Tilbury, Squires, and Thomas), Mayo Clinic, Rochester, Minnesota; Cardiovascular Department, Peking University People's Hospital, Beijing, China (Dr Ding); Department of Cardiology, Olmsted Medical Center, Rochester, Minnesota (Dr Tabatabaei); Halifax Health, Daytona Beach, Florida (Dr Tabatabaei); and Department of Medicine, John H. Stroger Hospital of Cook County, Chicago, Illinois (Dr Vardar)
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Beatty AL, Beckie TM, Dodson J, Goldstein CM, Hughes JW, Kraus WE, Martin SS, Olson TP, Pack QR, Stolp H, Thomas RJ, Wu WC, Franklin BA. A New Era in Cardiac Rehabilitation Delivery: Research Gaps, Questions, Strategies, and Priorities. Circulation 2023; 147:254-266. [PMID: 36649394 PMCID: PMC9988237 DOI: 10.1161/circulationaha.122.061046] [Citation(s) in RCA: 30] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Cardiac rehabilitation (CR) is a guideline-recommended, multidisciplinary program of exercise training, risk factor management, and psychosocial counseling for people with cardiovascular disease (CVD) that is beneficial but underused and with substantial disparities in referral, access, and participation. The emergence of new virtual and remote delivery models has the potential to improve access to and participation in CR and ultimately improve outcomes for people with CVD. Although data suggest that new delivery models for CR have safety and efficacy similar to traditional in-person CR, questions remain regarding which participants are most likely to benefit from these models, how and where such programs should be delivered, and their effect on outcomes in diverse populations. In this review, we describe important gaps in evidence, identify relevant research questions, and propose strategies for addressing them. We highlight 4 research priorities: (1) including diverse populations in all CR research; (2) leveraging implementation methodologies to enhance equitable delivery of CR; (3) clarifying which populations are most likely to benefit from virtual and remote CR; and (4) comparing traditional in-person CR with virtual and remote CR in diverse populations using multicenter studies of important clinical, psychosocial, and cost-effectiveness outcomes that are relevant to patients, caregivers, providers, health systems, and payors. By framing these important questions, we hope to advance toward a goal of delivering high-quality CR to as many people as possible to improve outcomes in those with CVD.
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Affiliation(s)
- Alexis L Beatty
- Department of Epidemiology and Biostatistics (A.L.B.), University of California, San Francisco.,Department of Medicine, Division of Cardiology (A.L.B.), University of California, San Francisco
| | - Theresa M Beckie
- College of Nursing (T.M.B.), University of South Florida, Tampa.,College of Medicine, Division of Cardiovascular Sciences (T.M.B.), University of South Florida, Tampa
| | - John Dodson
- Leon H. Charney Division of Cardiology, Department of Medicine (J.D.), New York University School of Medicine, New York.,Department of Population Health (J.D.), New York University School of Medicine, New York
| | - Carly M Goldstein
- The Weight Control and Diabetes Research Center, the Miriam Hospital, Providence, RI (C.M.G.).,Department of Psychiatry and Human Behavior, The Warren Alpert Medical School (C.M.G.), Brown University, Providence, RI
| | - Joel W Hughes
- Department of Psychological Sciences, Kent State University, OH (J.W.H.)
| | - William E Kraus
- Department of Medicine, Division of Cardiology, Duke University, Durham, NC (W.E.K.)
| | - Seth S Martin
- Department of Medicine, Division of Cardiology, Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD (S.S.M.)
| | - Thomas P Olson
- Department of Cardiovascular Medicine, Division of Preventive Cardiology, Mayo Clinic, Rochester, MN (T.P.O., R.J.T.)
| | - Quinn R Pack
- Department of Healthcare Delivery and Population Science, University of Massachusetts Medical School-Baystate, Springfield (Q.R.P.)
| | - Haley Stolp
- ASRT, Inc, Atlanta, GA (H.S.).,Centers for Disease Control and Prevention, Atlanta, GA (H.S.)
| | - Randal J Thomas
- Department of Cardiovascular Medicine, Division of Preventive Cardiology, Mayo Clinic, Rochester, MN (T.P.O., R.J.T.)
| | - Wen-Chih Wu
- Lifespan Cardiovascular Institute (W.-C.W.), Brown University, Providence, RI.,Division of Cardiology, Providence VA Medical Center, RI (W.-C.W.)
| | - Barry A Franklin
- William Beaumont Hospital, Royal Oak, MI (B.A.F.).,Oakland University William Beaumont School of Medicine, Rochester, MI (B.A.F.)
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Mingtai C, Guofu Z, Junteng C, Ling M, Jienan L, Zhihao L. Effectiveness and safety of Tiaogan formula in the treatment of coronary heart disease: A protocol for systematic review and meta-analysis. Medicine (Baltimore) 2022; 101:e32237. [PMID: 36550848 PMCID: PMC9771251 DOI: 10.1097/md.0000000000032237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND The morbidity and mortality of coronary heart disease (CHD) has remained high, which greatly increases people's economic burden. Several studies have showed that Tiaogan formula (TGF), as a kind of Chinese herbal medicine, was of benefit to relieving angina pectoris symptoms and improving the quality of life for CHD patients. However, the intensity of evidence has been poor, limiting the further clinical application of TGF to CHD. This systematic review and meta-analysis will assess the effectiveness and safety of studies of TGF in CHD patients. METHODS A systematic search for literature up to December 2022 will be conducted in following public electronic databases: PubMed, Embase, the Cochrane Library, China National Knowledge Infrastructure, Chinese Scientific Journals Database Database, and Wanfang Database. Inclusion criteria are randomized controlled trials of Tiaogan formula in the treatment of coronary heart disease. The primary outcome measures will be mortality, acute cardiovascular events, total efficacy rate, and improvement of angina symptoms. The secondary outcome measures will be electrocardiogram, levels of blood lipid, and adverse events. RevMan 5.4 software Cochrane Collaboration (London, United Kingdom) will be applied for data synthesis, sensitivity analysis, subgroup analysis, and risk of bias assessment. A funnel plot will be developed to evaluate reporting bias and Egger tests will be used to assess funnel plot symmetries. We will use the Grading of Recommendations Assessment, Development and Evaluation system to assess the quality of evidence. RESULTS This study will provide a systematic review of Tiaogan formula in the treatment of CHD. CONCLUSION This study will provide a high-quality synthesis of the effects and safety of Tiaogan formula in the treatment of CHD patients.
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Affiliation(s)
- Chen Mingtai
- Department of Cardiovascular Disease, Shenzhen Traditional Chinese Medicine Hospital, Shenzhen, China
| | - Zhong Guofu
- Intensive Care Unit, Shenzhen Traditional Chinese Medicine Hospital, Guangzhou University of Chinese Medicine, Shenzhen, China
| | - Chen Junteng
- Intensive Care Unit, Shenzhen Traditional Chinese Medicine Hospital, Guangzhou University of Chinese Medicine, Shenzhen, China
| | - Men Ling
- Nephrology Department, Shenzhen Traditional Chinese Medicine Hospital, Shenzhen, China
| | - Luan Jienan
- Department of Cardiovascular Disease, Shenzhen Traditional Chinese Medicine Hospital, Shenzhen, China
- * Correspondence: Luo Zhihao, Department of Emergency Center, Hainan Traditional Chinese Medicine Hospital, Hainan 570203, China (e-mail: ); Luan Jienan, Department of Cardiovascular Disease, Shenzhen Traditional Chinese Medicine Hospital, Shenzhen, China (e-mail: )
| | - Luo Zhihao
- Department of Emergency Center, Hainan Traditional Chinese Medicine Hospital, Hainan, China
- * Correspondence: Luo Zhihao, Department of Emergency Center, Hainan Traditional Chinese Medicine Hospital, Hainan 570203, China (e-mail: ); Luan Jienan, Department of Cardiovascular Disease, Shenzhen Traditional Chinese Medicine Hospital, Shenzhen, China (e-mail: )
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8
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Thygesen LC, Zinckernagel L, Dalal H, Egstrup K, Glümer C, Grønbæk M, Holmberg T, Køber L, la Cour K, Nakano A, Nielsen CV, Sibilitz KL, Tolstrup JS, Zwisler AD, Taylor RS. Cardiac rehabilitation for patients with heart failure: association with readmission and mortality risk. EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2022; 8:830-839. [PMID: 34850879 DOI: 10.1093/ehjqcco/qcab086] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 11/08/2021] [Accepted: 11/17/2021] [Indexed: 02/07/2023]
Abstract
AIMS To examine the temporal trends and factors associated with national cardiac rehabilitation (CR) referral and compare the risk of hospital readmission and mortality in those referred for CR versus no referral. METHODS AND RESULTS This cohort study includes all adult patients alive 120 days from incident heart failure (HF) identified by the Danish Heart Failure Registry (n = 33 257) between 2010 and 2018. Multivariable logistic regression models were used to assess the association between CR referral and patient factors and acute all-cause hospital readmission and mortality at 1 year following HF admission. Overall, 46.7% of HF patients were referred to CR, increasing from 31.7% in 2010 to 52.2% in 2018. Several factors were associated with lower odds of CR referral: male sex [odds ratio (OR): 0.85; 95% confidence interval: 0.80-0.89], older age, unemployment, retirement, living alone, non-Danish ethnic origin, low educational level, New York Heart Association (NYHA) class IV vs. I (OR: 0.75; 0.60-0.95), left ventricular ejection fraction >40%, and comorbidity (stroke, chronic kidney disease, atrial fibrillation/flutter, and diabetes). Myocardial infarction, arthritis, coronary artery bypass grafting, percutaneous coronary intervention, valvular surgery, NYHA class II, and use of angiotensin-converting enzyme inhibitors were associated with higher odds of CR referral. CR referral was associated with lower risk of acute all-cause readmission (OR: 0.92; 0.87-0.97) and all-cause mortality (OR: 0.65; 0.58-0.72). CONCLUSION Although increased over time, only one in two HF patients in Denmark were referred to CR in 2018. Strategies are needed to reduce referral disparities, focusing on subgroups of patients at highest risk of non-referral.
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Affiliation(s)
- Lau Caspar Thygesen
- National Institute of Public Health, University of Southern Denmark, Studiestræde 6, DK-1455 Copenhagen, Denmark
| | - Line Zinckernagel
- National Institute of Public Health, University of Southern Denmark, Studiestræde 6, DK-1455 Copenhagen, Denmark
| | - Hasnain Dalal
- University of Exeter Medical School, Knowledge Spa, Royal Cornwall Hospital, Truro, UK.,Primary Care Research Group, University of Exeter Medical School, St Luke's Campus, Exeter, UK
| | - Kenneth Egstrup
- Department of Cardiovascular Research, Odense University Hospital, Svendborg, Denmark
| | - Charlotte Glümer
- Center for Diabetes in the City of Copenhagen, Copenhagen, Denmark
| | - Morten Grønbæk
- National Institute of Public Health, University of Southern Denmark, Studiestræde 6, DK-1455 Copenhagen, Denmark
| | - Teresa Holmberg
- National Institute of Public Health, University of Southern Denmark, Studiestræde 6, DK-1455 Copenhagen, Denmark
| | - Lars Køber
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Karen la Cour
- Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Anne Nakano
- The Danish Clinical Registries (RKKP), Aarhus. Denmark
| | - Claus Vinther Nielsen
- Institute of Public Health, Aarhus University, Aarhus, Denmark.,DEFACTUM, Central Denmark Region, Aarhus, Denmark.,Regional Hospital West Jutland, Herning, Denmark
| | - Kirstine Lærum Sibilitz
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Janne Schurmann Tolstrup
- National Institute of Public Health, University of Southern Denmark, Studiestræde 6, DK-1455 Copenhagen, Denmark
| | - Ann Dorthe Zwisler
- REHPA, The Danish Knowledge Centre for Rehabilitation and Palliative Care, Odense University Hospital and University of Southern Denmark, Nyborg, Denmark
| | - Rod S Taylor
- National Institute of Public Health, University of Southern Denmark, Studiestræde 6, DK-1455 Copenhagen, Denmark.,Institute of Health and Well Being, University of Glasgow, Glasgow, UK
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Chen M, Liu M, Guo X, Zhou J, Yang H, Zhong G, Men L, Xie Y, Tong G, Liu Q, Luan J, Zhou H. Effects of Xinkeshu tablets on coronary heart disease patients combined with anxiety and depression symptoms after percutaneous coronary intervention: A meta-analysis. PHYTOMEDICINE : INTERNATIONAL JOURNAL OF PHYTOTHERAPY AND PHYTOPHARMACOLOGY 2022; 104:154243. [PMID: 35717809 DOI: 10.1016/j.phymed.2022.154243] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 05/17/2022] [Accepted: 06/04/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Xinkeshu tablets (XKS), a well-known Chinese patent drug, have been administered to coronary heart disease (CHD) patients with anxiety and depression after percutaneous coronary intervention (PCI). PURPOSE This meta-analysis aimed to systematically evaluate the clinical effects of XKS for treating CHD patients with anxiety and depression after PCI. METHODS Randomized controlled trials (RCTs) about XKS alone or combined with conventional drugs for the treatment of CHD patients with anxiety and depression after PCI were retrieved from 7 databases (MEDLINE, EMBASE, the Cochrane Library, China National Knowledge Infrastructure (CNKI), Chinese Scientific Journals Database (VIP) Database, Chinese Biomedical Database (CBM) and Wanfang Database) through November 2021. First, the studies were reviewed and screened by two independent assessors according to the eligibility criteria. Second, the methodological quality of the eligible studies was evaluated based on the Cochrane Collaboration's tool for assessing the risk of bias. Subsequently, meta-analysis was performed by using RevMan 5.4 software, and publication bias was evaluated by Stata 12.0 software. Finally, the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was applied to rate the quality of the evidence. RESULTS In total, 11 clinical RCTs involving 1000 patients were included in this study. This meta-analysis found that compared with conventional treatment alone, XKS combined with conventional treatment significantly improved the anxiety scale scores (SMD = -1.97, 95% CI -3.13 to -0.82; p = 0.0008; I2 = 98%), the depression scores (SMD = -2.80, 95% CI -4.49 to -1.10; p = 0.001; I2 = 98%), the scores on the Medical Outcomes Study 36 Item Short Form Health Survey (SF36) (MD = 11.22, 95% CI 4.19 to 18.26; p =0.002; I2 = 95%) and the blood lipid levels of total cholesterol (TC) (MD = -0.38, 95% CI -0.62 to -0.13; p = 0.003; I2 = 0%) and triglyceride (TG) (MD = -0.31, 95% CI -0.46 to -0.17; p < 0.0001; I2 = 0%). CONCLUSION The current evidence suggests that XKS might benefit CHD patients experiencing anxiety and depression after PCI by helping to improve their depression symptoms, TC and TG blood lipid levels. However, due to insufficient methodological quality of the studies, several risks of bias and inadequate reporting of the clinical data, more rigorous, multicenter, sufficient-sample and double-blind randomized clinical trials are warranted.
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Affiliation(s)
- Mingtai Chen
- Department of Cardiovascular Disease, Shenzhen Traditional Chinese Medicine Hospital, Guangzhou University of Chinese Medicine, Shenzhen, PR China; Faculty of Chinese Medicine and State Key Laboratory of Quality Research in Chinese Medicine, Macau University of Science and Technology, Taipa, Macao, PR China.
| | - Mengnan Liu
- Faculty of Chinese Medicine and State Key Laboratory of Quality Research in Chinese Medicine, Macau University of Science and Technology, Taipa, Macao, PR China; National Traditional Chinese Medicine Clinical Research Base and Department of Cardiovascular, Hospital (T.C.M) Affiliated to Southwest Medical University, Luzhou, Sichuan, PR China
| | - Xin Guo
- Faculty of Chinese Medicine and State Key Laboratory of Quality Research in Chinese Medicine, Macau University of Science and Technology, Taipa, Macao, PR China
| | - Jie Zhou
- Faculty of Chinese Medicine and State Key Laboratory of Quality Research in Chinese Medicine, Macau University of Science and Technology, Taipa, Macao, PR China
| | - Huayi Yang
- Faculty of Chinese Medicine and State Key Laboratory of Quality Research in Chinese Medicine, Macau University of Science and Technology, Taipa, Macao, PR China
| | - Guofu Zhong
- Intensive Care Unit, Shenzhen Traditional Chinese Medicine Hospital, Shenzhen, PR China
| | - Ling Men
- Department of Neurology, Shenzhen Traditional Chinese Medicine Hospital, Shenzhen, PR China
| | - Ying Xie
- School of Pharmacy and State Key Laboratory of Quality Research in Chinese Medicine, Macau University of Science and Technology, Macao, PR China
| | - Guangdong Tong
- Faculty of Chinese Medicine and State Key Laboratory of Quality Research in Chinese Medicine, Macau University of Science and Technology, Taipa, Macao, PR China; Department of Liver Disease, Shenzhen Traditional Chinese Medicine Hospital, Shenzhen, PR China
| | - Qiang Liu
- Department of Cardiovascular Disease, Shenzhen Traditional Chinese Medicine Hospital, Guangzhou University of Chinese Medicine, Shenzhen, PR China
| | - Jienan Luan
- Department of Cardiovascular Disease, Shenzhen Traditional Chinese Medicine Hospital, Guangzhou University of Chinese Medicine, Shenzhen, PR China
| | - Hua Zhou
- Faculty of Chinese Medicine and State Key Laboratory of Quality Research in Chinese Medicine, Macau University of Science and Technology, Taipa, Macao, PR China; Joint Laboratory for Translational Cancer Research of Chinese Medicine of the Ministry of Education of the People's Republic of China, Macau University of Science and Technology, Taipa, Macao, PR China; Guangdong Provincial Hospital of Chinese Medicine, Guangdong Provincial Academy of Chinese Medical Sciences, State Key Laboratory of Dampness Syndrome of Chinese Medicine, Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangdong-Hong Kong-Macau Joint Lab on Chinese Medicine and Immune Disease Research, Guangzhou, PR China.
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10
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Guduguntla V, Yaser JM, Keteyian SJ, Pagani FD, Likosky DS, Sukul D, Thompson MP. Variation in Cardiac Rehabilitation Participation During Aortic Valve Replacement Episodes of Care. Circ Cardiovasc Qual Outcomes 2022; 15:e009175. [PMID: 35559710 PMCID: PMC10068673 DOI: 10.1161/circoutcomes.122.009175] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Despite reported benefit in the setting of aortic valve replacement (AVR), cardiac rehabilitation (CR) utilization remains low, with few studies evaluating hospital and patient-level variation in CR participation. We explored determinants of CR variability during AVR episodes of care: transcatheter aortic valve replacement (TAVR) and surgical aortic valve replacement (SAVR). METHODS A cohort of 10 124 AVR episodes of care (TAVR n=5121 from 24 hospitals; SAVR n=5003 from 32 hospitals) were identified from the Michigan Value Collaborative statewide multipayer registry (2015-2019). CR enrollment was defined as the presence of a single professional or facility claim within 90 days of discharge: 93 797, 93 798, G0422, G0423. Annual trends and hospital variation in CR were described for TAVR, SAVR, and all AVR. Multilevel logistic regression was used to estimate effects of predictors and hospital risk-adjusted rates of CR enrollment. RESULTS Overall, 4027 (39.8%) patients enrolled in CR, with significant differences by treatment strategy: SAVR=50.9%, TAVR=28.9% (P<0.001). CR use after SAVR was significantly higher than after TAVR and increased over time for both modalities (P<0.001). There were significant differences in CR enrollment across age, gender, payer, and some comorbidities (P<0.05). At the hospital level, CR participation rates for all AVR varied 10-fold (4.8% to 68.7%) and were moderately correlated between SAVR and TAVR (Pearson r=0.56, P<0.01). CONCLUSIONS Substantial variation exists in CR participation during AVR episodes of care across hospitals. However, within-hospital CR participation rates were significantly correlated across treatment strategies. These findings suggest that CR participation is the product of hospital-specific practice patterns. Identifying hospital practices associated with higher CR participation can help assist future quality improvement efforts to increase CR use after AVR.
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Affiliation(s)
- Vinay Guduguntla
- Department of Internal Medicine, University of California, San Francisco (V.G.)
- Michigan Value Collaborative, University of Michigan, Ann Arbor (V.G., J.M.Y., M.P.T.)
| | - Jessica M Yaser
- Michigan Value Collaborative, University of Michigan, Ann Arbor (V.G., J.M.Y., M.P.T.)
| | - Steven J Keteyian
- Division of Cardiovascular Medicine, Henry Ford Health, Detroit, MI (S.J.K.)
| | - Francis D Pagani
- Department of Cardiac Surgery, Michigan Medicine, Ann Arbor (F.D.P., D.S.L., M.P.T.)
- Michigan Society of Thoracic and Cardiovascular Surgeons Quality Collaborative, Ann Arbor, MI (F.D.P., D.S.L., M.P.T.)
| | - Donald S Likosky
- Department of Cardiac Surgery, Michigan Medicine, Ann Arbor (F.D.P., D.S.L., M.P.T.)
| | - Devraj Sukul
- Department of Internal Medicine, University of California, San Francisco (V.G.)
- Division of Cardiovascular Medicine, Department of Internal Medicine, Michigan Medicine, Ann Arbor (D.S.)
| | - Michael P Thompson
- Michigan Value Collaborative, University of Michigan, Ann Arbor (V.G., J.M.Y., M.P.T.)
- Department of Cardiac Surgery, Michigan Medicine, Ann Arbor (F.D.P., D.S.L., M.P.T.)
- Michigan Society of Thoracic and Cardiovascular Surgeons Quality Collaborative, Ann Arbor, MI (F.D.P., D.S.L., M.P.T.)
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11
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Alfaraidhy MA, Regan C, Forman DE. Cardiac rehabilitation for older adults: current evidence and future potential. Expert Rev Cardiovasc Ther 2022; 20:13-34. [PMID: 35098848 PMCID: PMC8858649 DOI: 10.1080/14779072.2022.2035722] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Growth of the older adult demographic has resulted in an increased number of older patients with cardiovascular disease (CVD) in combination with comorbid diseases and geriatric syndromes. Cardiac rehabilitation (CR) is utilized to promote recovery and improve outcomes, but remains underutilized, particularly by older adults. CR provides an opportunity to address the distinctive needs of older adults, with focus on CVD as well as geriatric domains that often dominate management and outcomes. AREAS COVERED Utility of CR for CVD in older adults as well as pertinent geriatric syndromes (e.g. multimorbidity, frailty, polypharmacy, cognitive decline, psychosocial stress, and diminished function) that affect CVD management. EXPERT OPINION Mounting data substantiate the importance of CR as part of recovery for older adults with CVD. The application of CR as a standard therapy is especially important as the combination of CVD and geriatric syndromes catalyzes functional decline and can trigger progressive clinical deterioration and dependency. While benefits of CR for older adults with CVD are already evident, further reengineering of CR is necessary to better address the needs of older candidates who may be frail, especially as remote and hybrid formats of CR are becoming more widespread.
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Affiliation(s)
- Maha A. Alfaraidhy
- Department of Medicine, University of Maryland School of Medicine, Baltimore, MD,Department of Medicine, King Abdulaziz University School of Medicine, Jeddah, KSA
| | - Claire Regan
- University of Maryland School of Nursing, Baltimore, MD
| | - Daniel E. Forman
- Department of Medicine (Geriatrics and Cardiology), Section of Geriatric Cardiology, University of Pittsburgh, Pittsburgh, Pennsylvania, PA,Geriatric Research, Education, and Clinical Center, VA Pittsburgh Healthcare System, University of Pittsburgh, Pittsburgh, PA
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12
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Chen M, Zhong G, Men L, Liu Q, Luan J. Effectiveness and safety of Xinkeshu on coronary artery disease patients combined with anxiety and depression symptoms after percutaneous coronary intervention: A protocol for systematic review and meta-analysis. Medicine (Baltimore) 2021; 100:e27912. [PMID: 34797346 PMCID: PMC8601293 DOI: 10.1097/md.0000000000027912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 11/08/2021] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND It's known that coronary heart disease (CHD) patients after percutaneous coronary intervention (PCI) was significantly associated with anxiety and depression symptoms. Several studies have showed that Xinkeshu tablet (XKS), a kind of Chinese herbal medicine, could effectively improve post-PCI postoperative mood disorders in CHD patients. However, the intensity of evidence has been poor, limiting the further clinical application of XKS to patients above. This systematic review and meta-analysis will assess the effectiveness and safety of studies of XKS in CHD patients with anxiety and depression symptoms after PCI. METHODS A systematic literature search for articles up to December 2021 will be performed in following electronic databases: PubMed, Embase, the Cochrane Library, China National Knowledge Infrastructure, Chinese Scientific Journals Database Database, Chinese Biomedical Database, Chinese Biomedical Literature Service System, and Wanfang Database. Inclusion criteria are randomized controlled trials of XKS applied on patients with CHD and depression. The primary outcome measures will be CHD-related clinical evaluation (frequency of acute attack angina, severity of angina pectoris, electrocardiographic changes, amount of nitroglycerin) and the scores or reducing fractions of depressive and anxiety measuring scales (the Hospital Anxiety/Depression Scale or other widely used anxiety/depression scale). The safety outcome measures will be adverse events, liver and kidney function. RevMan 5.3 software will be used for data synthesis, sensitivity analysis, subgroup analysis, and risk of bias assessment. A funnel plot will be developed to evaluate reporting bias. Stata 12.0 will be used for meta-regression and Egger tests. We will use the Grading of Recommendations Assessment, Development and Evaluation system to assess the quality of evidence. DISCUSSION This study will provide a high-quality synthesis of the effects and safety of XKS for CHD patients with anxiety and depression symptoms after PCI. ETHICS AND DISSEMINATION This systematic review does not require ethics approval and will be submitted to a peer-reviewed journal.Trial registration number PROSPERO CRD42019131346.
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Affiliation(s)
- Mingtai Chen
- Department of Cardiovascular Disease, Shenzhen Traditional Chinese Medicine Hospital, Shenzhen, China
| | - Guofu Zhong
- Intensive Care Unit, Shenzhen Traditional Chinese Medicine Hospital, Guangzhou University of Chinese Medicine, Shenzhen, China
| | - Ling Men
- Nephrology Department, Shenzhen Traditional Chinese Medicine Hospital, Shenzhen, China
| | - Qiang Liu
- Department of Cardiovascular Disease, Shenzhen Traditional Chinese Medicine Hospital, Shenzhen, China
| | - Jienan Luan
- Department of Cardiovascular Disease, Shenzhen Traditional Chinese Medicine Hospital, Shenzhen, China
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13
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Thomas RJ, Petersen CE, Olson TP, Beatty AL, Ding R, Supervia M. Asynchronous and Synchronous Delivery Models for Home-Based Cardiac Rehabilitation: A SCIENTIFIC REVIEW. J Cardiopulm Rehabil Prev 2021; 41:407-412. [PMID: 34727559 PMCID: PMC9355022 DOI: 10.1097/hcr.0000000000000656] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
PURPOSE To review the principles, advantages, and disadvantages of asynchronous and synchronous delivery models of home-based cardiac rehabilitation (HBCR). METHODS We reviewed recently published systematic reviews and other publications of randomized studies of asynchronous and synchronous HBCR to assess principles, outcomes, and limitations of those delivery methods compared with center-based cardiac rehabilitation (CBCR). SUMMARY While most studies prior to 2016 involved asynchronous HBCR approaches to care, studies since 2016 have included asynchronous or synchronous delivery models. Both delivery models have been shown to help provide core components of cardiac rehabilitation (CR). Studies using either method have been shown to have similar short-term patient outcomes as CBCR, at least in low- to moderate-risk patients who have been studied. Asynchronous HBCR offers greater flexibility for patients and CR staff, while synchronous HBCR provides greater real-time oversight and feedback to patients.Asynchronous and synchronous HBCR is an option to consider for patients eligible for CR. Additional research is needed for both delivery models, applied separately or in combination, to compare their impact on shorter- and longer-term patient outcomes and to assess their impact in patient subgroups (referral diagnosis, women, elderly, underrepresented racial and ethnic minority groups, patients at a higher cardiovascular disease risk, patients with multiple comorbid conditions, etc).
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Affiliation(s)
- Randal J Thomas
- Cardiac Rehabilitation Program, Division of Preventive Cardiology, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota (Drs Thomas and Olson and Ms Petersen); Brigham Young University, Provo, Utah (Ms Petersen); Department of Epidemiology and Biostatistics and Department of Medicine (Cardiology), University of California, San Francisco (Dr Beatty); Department of Cardiology, Peiking University People's Hospital, Beijing, China (Dr Ding); and Gregorio Marañón General University Hospital, Gregorio Marañón Health Research Institute, Madrid, Spain (Dr Supervia)
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14
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Schopfer DW. Rural health disparities in chronic heart disease. Prev Med 2021; 152:106782. [PMID: 34499971 DOI: 10.1016/j.ypmed.2021.106782] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 07/02/2021] [Accepted: 09/04/2021] [Indexed: 01/02/2023]
Abstract
Rural communities suffer from significant disparities in cardiovascular health. The reasons for worse cardiovascular health and outcomes is due to a number of factors including economic, educational, and healthcare access. This commentary draws attention to these challenges and highlights how telemedicine may reduce a portion of this gap. In particular, an opportunity to modify cardiac rehabilitation programs to include a remotely-administered model using telemedicine is a novel method that holds promise.
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15
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Elnaggar A, von Oppenfeld J, Whooley MA, Merek S, Park LG. Applying Mobile Technology to Sustain Physical Activity After Completion of Cardiac Rehabilitation: Acceptability Study. JMIR Hum Factors 2021; 8:e25356. [PMID: 34473064 PMCID: PMC8446842 DOI: 10.2196/25356] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 05/24/2021] [Accepted: 07/04/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Many patients do not meet the recommended levels of physical activity after completing a cardiac rehabilitation (CR) program. Wearable activity trackers and mobile phone apps are promising potential self-management tools for maintaining physical activity after CR completion. OBJECTIVE This study aims to evaluate the acceptability of a wearable device, mobile app, and push messages to facilitate physical activity following CR completion. METHODS We used semistructured interviews to assess the acceptability of various mobile technologies after participation in a pilot randomized controlled trial. Intervention patients in the randomized controlled trial wore the Fitbit Charge 2, used the Movn mobile app, and received push messages on cardiovascular disease prevention and physical activity for over 2 months. We asked 26 intervention group participants for feedback about their experience with the technology and conducted semistructured individual interviews with 7 representative participants. We used thematic analysis to create the main themes from individual interviews. RESULTS Our sample included participants with a mean age of 66.7 (SD 8.6) years; 23% (6/26) were female. Overall, there were varying levels of satisfaction with different technology components. There were 7 participants who completed the satisfaction questionnaires and participated in the interviews. The Fitbit and Movn mobile app received high satisfaction scores of 4.86 and 4.5, respectively, whereas push messages had a score of 3.14 out of 5. We identified four main themes through the interviews: technology use increased motivation to be physically active, technology use served as a reminder to be physically active, recommendations for technology to improve user experience, and desire for personal feedback. CONCLUSIONS By applying a wearable activity tracker, mobile phone app, and push messages, our study showed strong potential for the adoption of new technologies by older adults to maintain physical activity after CR completion. Future research should include a larger sample over a longer period using a mixed methods approach to assess the efficacy of technology use for promoting long-term physical activity behavior in older adults.
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Affiliation(s)
- Abdelaziz Elnaggar
- Department of Community Health Systems, School of Nursing, University of California San Francisco, San Francisco, CA, United States
| | | | - Mary A Whooley
- Veterans Affairs Medical Center, San Francisco, CA, United States.,Department of Medicine, University of California San Francisco, San Francisco, CA, United States.,Department of Epidemiology & Biostatistics, University of California San Francisco, San Francisco, CA, United States
| | - Stephanie Merek
- Veterans Affairs Medical Center, San Francisco, CA, United States
| | - Linda G Park
- Department of Community Health Systems, School of Nursing, University of California San Francisco, San Francisco, CA, United States.,Veterans Affairs Medical Center, San Francisco, CA, United States
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16
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Abstract
PURPOSE OF REVIEW To summarize recent innovations in cardiac rehabilitation and provide a view towards the future of cardiac rehabilitation as it adjusts to the pressures of a global pandemic. RECENT FINDINGS Although cardiac rehabilitation has been shown to result in a mortality benefit, research continues to enumerate the benefits of cardiac rehabilitation to patient function and quality of life in a growing range of cardiovascular diseases. In addition, new methodologies and new models of cardiac rehabilitation have emerged with the goal of increasing patient referral and participation. SUMMARY Cardiac rehabilitation continues to evolve and adapt to serve a growing and diversifying number of patients with cardiovascular disease with the goal of both decreasing mortality and improving patient function.
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17
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Li Y, Babazono A, Ohmori T, Jamal A, Yoshida S, Kim SA, Fujita T, Liu N. Health Inequality Among Older Adults with Percutaneous Coronary Intervention and Universal Health Coverage in Japan. Popul Health Manag 2021; 25:23-30. [PMID: 34076535 DOI: 10.1089/pop.2021.0070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
This study aimed to comprehensively evaluate whether income affects long-term health outcomes for older patients who underwent percutaneous coronary intervention (PCI) provided by a universal health coverage system. Data were from the Latter Stage Elderly Healthcare Insurance database in Fukuoka Prefecture, Japan. A total of 5625 individuals aged ≥65 years who underwent PCI in 2014-2016 were included. Cox proportional hazards models were used to assess the association between income status and the incidence of health outcomes. With a median follow-up of 1095 days, 554 acute myocardial infarction (AMI) cases, 1075 stroke cases, 1690 repeat revascularization cases, and 1094 deaths were observed. Risk of all-cause mortality decreased significantly with increasing income level in both unadjusted and adjusted Cox regression models. Patients in the low-income level had a significantly higher rate of AMI (log-rank P = 0.003), stroke (log-rank P = 0.039), and all-cause mortality (log-rank P = 0.001) compared with patients in the high-income level. Observed rates for repeat revascularization also were high in the first year after PCI. In the Japanese universal health setting, low-income patients had a comparatively higher mortality risk after PCI. Poor long-term outcomes might be attributed to patients' baseline characteristics rather than treatment processes.
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Affiliation(s)
- Yunfei Li
- Department of Health Care Administration and Management, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Akira Babazono
- Department of Health Care Administration and Management, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Takashi Ohmori
- Department of Transitional and Palliative Care, Iizuka Hospital, Iizuka, Japan
| | - Aziz Jamal
- Department of Health Care Administration and Management, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.,Health Administration Program, Faculty of Business and Management, Universiti Teknologi MARA, Selangor, Malaysia
| | - Shinichiro Yoshida
- Department of Health Care Administration and Management, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Sung-A Kim
- Department of Health Care Administration and Management, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Takako Fujita
- Department of Health Care Administration and Management, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.,Department of Health Sciences, Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Ning Liu
- Department of Preventive Medicine and Community Health, University of Occupational and Environmental Health, Kitakyushu, Japan
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18
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Thompson MP, Yaser JM, Hou H, Syrjamaki JD, DeLucia A, Likosky DS, Keteyian SJ, Prager RL, Gurm HS, Sukul D. Determinants of Hospital Variation in Cardiac Rehabilitation Enrollment During Coronary Artery Disease Episodes of Care. Circ Cardiovasc Qual Outcomes 2021; 14:e007144. [PMID: 33541107 DOI: 10.1161/circoutcomes.120.007144] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Cardiac rehabilitation (CR) is associated with improved outcomes for patients with coronary artery disease (CAD). However, CR enrollment remains low and there is a dearth of real-world data on hospital-level variation in CR enrollment. We sought to explore determinants of hospital variability in CR enrollment during CAD episodes of care: medical management of acute myocardial infarction (AMI-MM), percutaneous coronary intervention (PCI), and coronary artery bypass grafting (CABG). METHODS A cohort of 71 703 CAD episodes of care were identified from 33 hospitals in the Michigan Value Collaborative statewide multipayer registry (2015 to 2018). CR enrollment was defined using professional and facility claims and compared across treatment strategies: AMI-MM (n=18 678), PCI (n=41 986), and CABG (n=11 039). Hierarchical logistic regression was used to estimate effects of predictors and hospital risk-adjusted rates of CR enrollment. RESULTS Overall, 20 613 (28.8%) patients enrolled in CR, with significant differences by treatment strategy: AMI-MM=13.4%, PCI=29.0%, CABG=53.8% (P<0.001). There were significant differences in CR enrollment across age groups, comorbidity status, and payer status. At the hospital-level, there was over 5-fold variation in hospital risk-adjusted CR enrollment rates (9.8%-51.6%). Hospital-level CR enrollment rates were highly correlated across treatment strategy, with the strongest correlation between AMI-MM versus PCI (R2=0.72), followed by PCI versus CABG (R2=0.51) and AMI-MM versus CABG (R2=0.46, all P<0.001). CONCLUSIONS Substantial variation exists in CR enrollment during CAD episodes of care across hospitals. However, within-hospital CR enrollment rates were significantly correlated across all treatment strategies. These findings suggest that CR enrollment during CAD episodes of care is the product of hospital-specific rather than treatment-specific practice patterns.
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Affiliation(s)
- Michael P Thompson
- Department of Cardiac Surgery (M.P.T., H.H., D.S.L., R.L.P.), Michigan Medicine, Ann Arbor MI.,Michigan Value Collaborative, University of Michigan, Ann Arbor (M.P.T., J.M.Y., J.D.S.)
| | - Jessica M Yaser
- Michigan Value Collaborative, University of Michigan, Ann Arbor (M.P.T., J.M.Y., J.D.S.)
| | - Hechuan Hou
- Department of Cardiac Surgery (M.P.T., H.H., D.S.L., R.L.P.), Michigan Medicine, Ann Arbor MI
| | - John D Syrjamaki
- Michigan Value Collaborative, University of Michigan, Ann Arbor (M.P.T., J.M.Y., J.D.S.)
| | - Alphonse DeLucia
- Department of Cardiac Surgery, Bronson Methodist Hospital, Kalamazoo, MI (A.D.)
| | - Donald S Likosky
- Department of Cardiac Surgery (M.P.T., H.H., D.S.L., R.L.P.), Michigan Medicine, Ann Arbor MI.,Michigan Society of Thoracic and Cardiovascular Surgeons Quality Collaborative, Ann Arbor, MI (D.S.L., R.L.P.)
| | - Steven J Keteyian
- Division of Cardiovascular Medicine, Henry Ford Health System, Detroit, MI (S.J.K.)
| | - Richard L Prager
- Department of Cardiac Surgery (M.P.T., H.H., D.S.L., R.L.P.), Michigan Medicine, Ann Arbor MI.,Michigan Society of Thoracic and Cardiovascular Surgeons Quality Collaborative, Ann Arbor, MI (D.S.L., R.L.P.)
| | - Hitinder S Gurm
- Division of Cardiovascular Medicine, Department of Internal Medicine (H.S.G., D.S.), Michigan Medicine, Ann Arbor MI.,Blue Cross Blue Shield of Michigan Cardiovascular Consortium, (BMC2), Ann Arbor, MI (H.S.G., D.S.)
| | - Devraj Sukul
- Division of Cardiovascular Medicine, Department of Internal Medicine (H.S.G., D.S.), Michigan Medicine, Ann Arbor MI.,Blue Cross Blue Shield of Michigan Cardiovascular Consortium, (BMC2), Ann Arbor, MI (H.S.G., D.S.)
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19
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Kamiya K, Sato Y, Takahashi T, Tsuchihashi-Makaya M, Kotooka N, Ikegame T, Takura T, Yamamoto T, Nagayama M, Goto Y, Makita S, Isobe M. Multidisciplinary Cardiac Rehabilitation and Long-Term Prognosis in Patients With Heart Failure. Circ Heart Fail 2020; 13:e006798. [DOI: 10.1161/circheartfailure.119.006798] [Citation(s) in RCA: 56] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Background:
Exercise-based cardiac rehabilitation (CR) improves health-related quality of life and exercise capacity in patients with heart failure (HF). However, CR efficacy in patients with HF who are elderly, frail, or have HF with preserved ejection fraction remains unclear. We examined whether participation in multidisciplinary outpatient CR is associated with long-term survival and rehospitalization in patients with HF, with subgroup analysis by age, sex, comorbidities, frailty, and HF with preserved ejection fraction.
Methods:
This multicenter retrospective cohort study was performed in patients hospitalized for acute HF at 15 hospitals in Japan, 2007 to 2016. The primary outcome (composite of all-cause mortality and HF rehospitalization after discharge) and secondary outcomes (all-cause mortality and HF rehospitalization) were analyzed in outpatient CR program participants versus nonparticipants.
Results:
Of the 3277 patients, 26% (862) participated in outpatient CR. After propensity matching for potential confounders, 1592 patients were included (n=796 pairs), of which 511 had composite outcomes (223 [14%] all-cause deaths and 392 [25%] HF rehospitalizations, median 2.4-year follow-up). Hazard ratios associated with CR participation were 0.77 (95% CI, 0.65–0.92) for composite outcome, 0.67 (95% CI, 0.51–0.87) for all-cause mortality, and 0.82 (95% CI, 0.67–0.99) for HF-related rehospitalization. CR participation was also associated with numerically lower rates of composite outcome in patients with HF with preserved ejection fraction or frail patients.
Conclusions:
Outpatient CR participation was associated with substantial prognostic benefit in a large HF cohort regardless of age, sex, comorbidities, frailty, and HF with preserved ejection fraction.
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Affiliation(s)
- Kentaro Kamiya
- Department of Rehabilitation, School of Allied Health Sciences (K.K.), Kitasato University, Kanagawa, Japan
| | - Yukihito Sato
- Department of Cardiology, Hyogo Prefectural Amagasaki General Medical Center, Japan (Y.S.)
| | - Tetsuya Takahashi
- Department of Physical Therapy, Juntendo University, Tokyo, Japan (T. Takahashi)
| | | | - Norihiko Kotooka
- Department of Cardiovascular Medicine, Saga University, Japan (N.K.)
| | - Toshimi Ikegame
- Department of Nursing (T.I.), Sakakibara Heart Institute, Tokyo, Japan
| | - Tomoyuki Takura
- Department of Healthcare Economics and Health Policy, Graduate School of Medicine, The University of Tokyo, Japan (T. Takura)
| | - Takanobu Yamamoto
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Japan (T.Y.)
| | - Masatoshi Nagayama
- Department of Cardiovascular Medicine (M.N.), Sakakibara Heart Institute, Tokyo, Japan
| | - Yoichi Goto
- Yoka Municipal Hospital, Hyogo, Japan (Y.G.)
| | - Shigeru Makita
- Department of Cardiac Rehabilitation, Saitama Medical University International Medical Center, Japan (S.M.)
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20
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Eijsvogels TMH, Maessen MFH, Bakker EA, Meindersma EP, van Gorp N, Pijnenburg N, Thompson PD, Hopman MTE. Association of Cardiac Rehabilitation With All-Cause Mortality Among Patients With Cardiovascular Disease in the Netherlands. JAMA Netw Open 2020; 3:e2011686. [PMID: 32716516 DOI: 10.1001/jamanetworkopen.2020.11686] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
IMPORTANCE Cardiac rehabilitation (CR) is an effective strategy to improve clinical outcomes, but it remains underused in some subgroups of patients with cardiovascular disease (CVD). OBJECTIVE To investigate the implications of sex, age, socioeconomic status, CVD diagnosis, cardiothoracic surgery, and comorbidity for the association between CR participation and all-cause mortality. DESIGN, SETTING, AND PARTICIPANTS Observational cohort study with patient enrollment between July 1, 2012, and December 31, 2017, and a follow-up to March 19, 2020. The dates of analysis were March to May 2020. This study was performed among Dutch patients with CVD with a multidisciplinary outpatient CR program indication and who were insured at Coöperatie Volksgezondheidszorg, one of the largest health insurance companies in the Netherlands. Among 4.1 million beneficiaries, patients with CVD with an acute coronary event (myocardial infarction or unstable angina pectoris), stable angina pectoris, chronic heart failure, or cardiothoracic surgery (coronary artery bypass grafting, valve replacement, or percutaneous coronary intervention) were identified by inpatient diagnosis codes and included in the study. MAIN OUTCOMES AND MEASURES Cox proportional hazards models were used to evaluate the association between CR participation and all-cause mortality. Stabilized inverse propensity score weighting was used to account for patient and disease characteristics associated with CR participation. RESULTS Among 83 687 eligible patients with CVD (mean [SD] age, 67 [12] years; 60.4% [n = 50 512] men), only 31.3% (n = 26 171) participated in CR, with large variation across different subgroups (range, 5.1%-73.0%). During a mean (SD) of 4.7 (1.8) years of follow-up, 1966 CR participants (7.5%) and 13 443 CR nonparticipants (23.4%) died. After multivariable adjustment, CR participation was associated with a 32% lower risk of all-cause mortality (adjusted hazard ratio, 0.68; 95% CI, 0.65-0.71) compared with nonparticipation. Sex, age, socioeconomic status, and comorbidity did not alter risk reduction after CR participation, but a statistically significant interaction association was found across categories of CVD diagnosis and cardiothoracic surgery. Larger reductions in risk estimates for all-cause mortality were found after CR participation for STEMI (adjusted HR, 0.59; 95% CI, 0.52-0.68 vs 0.72; 95% CI, 0.65-0.79; P < .001), NSTEMI (adjusted HR, 0.64; 95% CI, 0.58-0.70 vs 0.72; 95% CI, 0.65-0.79; P < .001), and stable AP (adjusted HR, 0.69; 95% CI, 0.63-0.76 vs 0.72; 95% CI, 0.65-0.79; P < .001) compared with patients with chronic heart failure, whereas unstable AP had a smaller risk reduction (adjusted HR, 0.75; 95% CI, 0.67-0.85 vs 0.72; 95% CI, 0.65-0.79; P < .001). CONCLUSIONS AND RELEVANCE In this cohort study, CR participation was associated with a 32% risk reduction in all-cause mortality, and this benefit was independent of sex, age, socioeconomic status, and comorbidity. These findings reinforce the importance of CR participation in secondary prevention and highlight the possibility that CR should be prescribed more widely to vulnerable patients with CVD, such as older adults with chronic diseases or multimorbidity.
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Affiliation(s)
- Thijs M H Eijsvogels
- Department of Physiology, Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Martijn F H Maessen
- Department of Physiology, Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, the Netherlands
- Coöperatie Volksgezondheidszorg, Business Intelligence Services, Arnhem, the Netherlands
| | - Esmée A Bakker
- Department of Physiology, Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, the Netherlands
- Research Institute for Sports and Exercise Sciences, Liverpool John Moores University, Liverpool, United Kingdom
| | - Esther P Meindersma
- Department of Cardiology, Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Niels van Gorp
- Coöperatie Volksgezondheidszorg, Business Intelligence Services, Arnhem, the Netherlands
| | - Nicole Pijnenburg
- Coöperatie Volksgezondheidszorg, Business Intelligence Services, Arnhem, the Netherlands
| | - Paul D Thompson
- Division of Cardiology, Hartford Hospital, Hartford, Connecticut
| | - Maria T E Hopman
- Department of Physiology, Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, the Netherlands
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21
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Tai Chi Improves Coronary Heart Disease Risk by Inactivating MAPK/ERK Pathway through Serum miR-126. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2020; 2020:4565438. [PMID: 32382289 PMCID: PMC7199556 DOI: 10.1155/2020/4565438] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Revised: 03/29/2020] [Accepted: 04/04/2020] [Indexed: 01/20/2023]
Abstract
Background Tai Chi is effective in preventing heart disease (CHD) risk, but the molecular mechanism remains unclear. Mitogen-activated protein kinase (MAPK) signaling plays a critical role in the pathogenesis of CHD and can be activated by miR-126. Tai Chi may exert its protective function through the miR-126-modulated MAPK pathway. Methods The CHD patients after PCI were randomized into the CG group (CG) (n = 19, normal care) and Tai Chi group (TG) (Tai Chi intervention, n = 17). Epicardial adipose tissue volume (EATV) (one main adverse cardiovascular event of CHD), HR (heart rate), QoL (quality of life) scores, and balance performance were measured in the two groups. The body fat content, abdominal subcutaneous fat, and visceral fat were measured to reflect the improvement of adipose tissue dysfunction. The levels of miR-126 and MAPK-associated molecules were measured in peripheral blood leukocytes. Meanwhile, the effects of miR-126 silence and mimic on MAPK-associated molecules were also explored in cardiac cell H9C2. Results After the 3-month intervention, Tai Chi reduced EATV and HR and increased QoL scores and balance performance, respectively (P < 0.05). The fat percentage, body fat mass, and BMI were also significantly reduced after Tai Chi intervention (P < 0.05). The levels of miR-126, MAPK, JNK, and ERK in the TG group were lower than those in the CG group (P < 0.05). The miR-126 levels had a strong relationship with the values of EATV, HR, and QoL scores (P < 0.05). miR-126 silence or mimic inactivated or activated MAPK-associated molecules in the cardiac cell lines. Conclusions Tai Chi improved CHD risk by inactivating the MAPK/ERK pathway via serum miR-126.
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Krishnamurthi N, Schopfer DW, Shen H, Whooley MA. Association of Cardiac Rehabilitation With Survival Among US Veterans. JAMA Netw Open 2020; 3:e201396. [PMID: 32196104 PMCID: PMC7084171 DOI: 10.1001/jamanetworkopen.2020.1396] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Participation in cardiac rehabilitation (CR) programs at Veterans Affairs (VA) facilities is low. Most veterans receive CR through purchased care at non-VA programs. However, limited literature exists on the comparison of outcomes between VA and non-VA CR programs. OBJECTIVE To compare 1-year mortality and 1-year readmission rates for myocardial infarction or coronary revascularization between VA vs non-VA CR participants. DESIGN, SETTING, AND PARTICIPANTS This cohort study included 7320 patients hospitalized for myocardial infarction or coronary revascularization at the VA between 2010 and 2014 who did not die within 30 days of discharge and who participated in 2 or more CR sessions after discharge. The study excluded individuals hospitalized for ischemic heart disease after December 2014 when the VA Choice Act changed referral criteria for non-VA care. Data analysis was performed from November 2019 to January 2020. EXPOSURES Participation in 2 or more CR sessions within 12 months of discharge at a VA or non-VA facility. MAIN OUTCOMES AND MEASURES The 1-year all-cause mortality and 1-year readmission rates for myocardial infarction or coronary revascularization from date of discharge were compared between VA vs non-VA CR participants using Cox proportional hazards models with inverse probability treatment weighting. RESULTS The 7320 veterans with ischemic heart disease who participated in CR programs had a mean (SD) age of 65.13 (8.17) years and were predominantly white (6005 patients [82.0%]), non-Hispanic (6642 patients [91.0%]), and male (7191 patients [98.2%]). Among these 7320 veterans, 2921 (39.9%) attended a VA facility, and 4399 (60.1%) attended a non-VA CR facility. Black and Hispanic veterans were more likely to attend CR programs at VA facilities (509 patients [17.4%] and 378 patients [12.9%], respectively), whereas white veterans were more likely to attend CR programs at non-VA facilities (3759 patients [85.5%]). After inverse probability treatment weighting, rates of 1-year mortality were 1.7% among VA CR participants vs 1.3% among non-VA CR participants (hazard ratio, 1.32; 95% CI, 0.90-1.94; P = .15). Rates of readmission for myocardial infarction or revascularization during the 12 months after discharge were 4.9% among VA CR participants vs 4.4% among non-VA CR participants (hazard ratio, 1.06; 95% CI, 0.83-1.35; P = .62). CONCLUSIONS AND RELEVANCE These findings suggest that rates of 1-year mortality and 1-year readmission for myocardial infarction or revascularization did not differ for participants in VA vs non-VA cardiac rehabilitation programs. Eligible patients with ischemic heart disease should participate in CR programs regardless of where they are provided.
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Affiliation(s)
- Nirupama Krishnamurthi
- San Francisco Veterans Affairs Medical Center, San Francisco, California
- Icahn School of Medicine at Mount Sinai St Luke’s and Mount Sinai West, New York, New York
| | - David W. Schopfer
- San Francisco Veterans Affairs Medical Center, San Francisco, California
- Department of Medicine, University of California, San Francisco
| | - Hui Shen
- San Francisco Veterans Affairs Medical Center, San Francisco, California
- Department of Medicine, University of California, San Francisco
| | - Mary A. Whooley
- San Francisco Veterans Affairs Medical Center, San Francisco, California
- Department of Medicine, University of California, San Francisco
- Department of Epidemiology and Biostatistics, University of California, San Francisco
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Occurrence and predictive factors of restenosis in coronary heart disease patients underwent sirolimus-eluting stent implantation. Ir J Med Sci 2020; 189:907-915. [PMID: 31989420 DOI: 10.1007/s11845-020-02176-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Accepted: 01/20/2020] [Indexed: 01/06/2023]
Abstract
BACKGROUND This study aimed to investigate the occurrence and predictive factors of restenosis in coronary heart disease (CHD) patients underwent percutaneous coronary intervention (PCI) with sirolimus-eluting stent (SES). METHODS Demographic data, clinical features, and laboratory tests of 398 CHD patients underwent PCI with SES were retrospectively reviewed. Coronary angiography was performed to evaluate coronary stenosis before PCI and in-stent restenosis at 1-year follow-up. RESULTS There were 37 (9.3%) patients suffered restenosis, but 361 (90.7%) patients did not develop restenosis at 1-year follow-up. Demographic characteristic (age), cardiovascular risk factors (hypertension and hyperuricemia), biochemical indexes (fasting blood-glucose, total cholesterol, low density lipoprotein cholesterol (LDL-C) and high-sensitivity C-reactive protein (HsCRP)), cardiac function index (cardiac troponin I), lesion features (multivessel artery lesions, target lesion at left circumflex artery (LCX), two target lesions and length of target lesion), and operation procedure (length of stent) were correlated with higher restenosis risk. Moreover, age, hypertension, diabetes mellitus, LDL-C, HsCRP, and target lesion at LCX were independent predictive factors for raised restenosis risk. Based on these independent predictive factors, we established a restenosis risk prediction model, and receiver-operating characteristic curves displayed that this model exhibited an excellent predictive value for higher restenosis risk (areas under the curve 0.953 (95% CI 0.926-0.981)). CONCLUSION Our findings provide a new insight into the prediction for restenosis in CHD patients underwent PCI with SES.
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Beatty AL, Doll JA, Schopfer DW, Maynard C, Plomondon ME, Shen H, Whooley MA. Cardiac Rehabilitation Participation and Mortality After Percutaneous Coronary Intervention: Insights From the Veterans Affairs Clinical Assessment, Reporting, and Tracking Program. J Am Heart Assoc 2019; 7:e010010. [PMID: 30371315 PMCID: PMC6404876 DOI: 10.1161/jaha.118.010010] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Background Cardiac rehabilitation (CR) is strongly recommended after percutaneous coronary intervention (PCI), but it is underused. We sought to evaluate CR participation variation after PCI and its association with mortality among veterans. Methods and Results Patients undergoing PCI between 2007 and 2011 were identified in the Veterans Affairs Clinical Assessment, Reporting, and Tracking database and followed up until January 25, 2017. We excluded patients who died within 30 days of PCI and calculated the percentage participating in ≥1 outpatient CR visits within 12 months after PCI. We constructed multivariable hierarchical logistic regression models for CR participation, clustered by facility. We estimated propensity scores for CR participation, matched participants and nonparticipants by propensity score, calculated mortality rates, and estimated the association with mortality using Cox proportional hazards models. Participation in CR after PCI was 6.9% (2986/43 319) and varied significantly by PCI facility (range, 0%-36%). After 6.1 years median follow-up, CR participants had a 33% lower mortality rate than all nonparticipants (3.8 versus 5.7 deaths/100 person-years; hazard ratio, 0.67; 95% confidence interval, 0.61-0.75; P<0.001) and a 26% lower mortality rate than 2986 propensity-matched nonparticipants (3.8 versus 5.1 deaths/100 person-years; hazard ratio, 0.74; 95% confidence interval, 0.65-0.84; P<0.001). Participants attending ≥36 sessions had the lowest mortality rate (2.4 deaths/100 person-years; hazard ratio, 0.47; 95% confidence interval, 0.36-0.60; P<0.001). Conclusions CR participation after PCI among veterans is low overall, with significant facility-level variation. CR participation is associated with lower mortality rates in veterans. Additional efforts are needed to promote CR participation after PCI among veterans.
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Affiliation(s)
- Alexis L Beatty
- 1 Center of Innovation for Veteran-Centered and Value-Driven Care Veterans Affairs Puget Sound Health Care System Seattle WA.,2 Department of Medicine University of Washington Seattle WA
| | - Jacob A Doll
- 1 Center of Innovation for Veteran-Centered and Value-Driven Care Veterans Affairs Puget Sound Health Care System Seattle WA.,2 Department of Medicine University of Washington Seattle WA
| | - David W Schopfer
- 4 Department of Medicine San Francisco VA Medical Center San Francisco CA.,5 Department of Medicine University of California San Francisco CA
| | - Charles Maynard
- 1 Center of Innovation for Veteran-Centered and Value-Driven Care Veterans Affairs Puget Sound Health Care System Seattle WA.,3 School of Public Health University of Washington Seattle WA
| | - Mary E Plomondon
- 7 Veterans Affairs Clinical Assessment, Reporting, and Tracking VA Eastern Colorado Health Care System Denver CO
| | - Hui Shen
- 4 Department of Medicine San Francisco VA Medical Center San Francisco CA.,5 Department of Medicine University of California San Francisco CA
| | - Mary A Whooley
- 2 Department of Medicine University of Washington Seattle WA.,4 Department of Medicine San Francisco VA Medical Center San Francisco CA.,5 Department of Medicine University of California San Francisco CA.,6 Department of Epidemiology and Biostatistics University of California San Francisco CA
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25
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Standley RA, Vega RB. Furthering Precision Medicine Genomics With Healthy Living Medicine. Prog Cardiovasc Dis 2019; 62:60-67. [DOI: 10.1016/j.pcad.2018.12.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Accepted: 12/28/2018] [Indexed: 12/23/2022]
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