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Brust M, Gebhardt WA, Ter Hoeve N, Numans ME, Kiefte-de Jong JC. Exploring timing and delivery of lifestyle advice following an acute cardiac event hospitalization: The cardiac patient's perspective. Patient Educ Couns 2024; 124:108279. [PMID: 38565073 DOI: 10.1016/j.pec.2024.108279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 03/19/2024] [Accepted: 03/25/2024] [Indexed: 04/04/2024]
Abstract
OBJECTIVE To explore the perspective of cardiac patients regarding the timing and manner of delivering lifestyle advice following an acute cardiac event hospitalization. METHODS Dutch cardiac patients who experienced a cardiac event hospitalization participated in a semi-structured interview (n = 14) or a cross-sectional survey study (n = 119). RESULTS Our findings indicate that cardiac patients are receptive to lifestyle advice throughout the care trajectory. Advice delivered by a cardiologist had the highest self-reported impact. Furthermore, receiving advice at multiple phases during the care trajectory was associated with a greater intention to change lifestyle (B = 0.37, CI = 0.17 - 0.57). Patients favored clear-cut, feasible, and friendly but confronting advice. Moreover, they stressed the importance of advice being aligned with their identity and beliefs about the causes of their disease. CONCLUSION The period following an acute cardiac event provides a unique opportunity to offer tailored and patient-centered lifestyle advice. This "teachable window" for lifestyle change, when used wisely, may improve health outcomes for cardiac patients. PRACTICE IMPLICATIONS Healthcare professionals should initiate lifestyle advice already during hospitalization and continue during follow-up appointments and cardiac rehabilitation. Advice should be feasible and empathy-based, as well as tailored to the patient's needs, values, and perceptions of the causes of their cardiovascular disease.
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Affiliation(s)
- Michelle Brust
- Department of Public Health and Primary Care/ Health Campus The Hague, Leiden University Medical Center, The Hague, the Netherlands.
| | - Winifred A Gebhardt
- Health, Medical and Neuropsychology Unit, Institute of Psychology, Leiden University, the Netherlands.
| | - Nienke Ter Hoeve
- Capri Cardiac Rehabilitation, Rotterdam, the Netherlands; Erasmus University Medical Centre, Department of Rehabilitation Medicine, Rotterdam, the Netherlands.
| | - Mattijs E Numans
- Department of Public Health and Primary Care/ Health Campus The Hague, Leiden University Medical Center, The Hague, the Netherlands.
| | - Jessica C Kiefte-de Jong
- Department of Public Health and Primary Care/ Health Campus The Hague, Leiden University Medical Center, The Hague, the Netherlands.
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McGowan H, Gutenberg J, Leitner V, Mühlhauser K, Breda A, Fischer M, Globits S, Grote V, Kiesl D, Mayr K, Muntean M, Podolsky A, Niebauer J, Crutzen R, Kulnik ST. Exploring physical activity preferences and motivation in long-term cardiac prevention: An Austrian cross-sectional survey. PLoS One 2024; 19:e0302226. [PMID: 38753841 PMCID: PMC11098351 DOI: 10.1371/journal.pone.0302226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 03/29/2024] [Indexed: 05/18/2024] Open
Abstract
Cardiac rehabilitation (CR) patients often do not sustain physical activity (PA) behaviour in the long run, once they progress into a self-management stage of secondary prevention. This study aimed to explore former CR patients' PA preferences, determinants (i.e., influencing factors) and motivation for sustained PA engagement. We conducted a cross-sectional multi-centre survey using an original questionnaire based on prior qualitative interviews with cardiac patients. Five CR centres in Austria posted 500 questionnaires to former CR patients who had completed CR approximately three years prior, and 117 patients (23%) responded. Descriptive analysis was used to analyse closed-ended questions, and self-determination theory (SDT) was applied as a qualitative framework to analyse open-ended questions concerning motivation for PA engagement. Patients were generally physically active, but the majority (75.3%) did not fulfil the World Health Organisation's recommendations for aerobic PA and muscle strengthening. Most patients preferred being physically active outdoors (70%), engaging in aerobic-related (95%), individual and non-competitive exercises, with cycling (52%), walking (32%) and hiking (25%) among the most popular activities. Main determinants of PA were health, pain and motivation for 80%, 68%, 67% of patients, respectively. A subset of patients (77%) expanded on their motivations behind PA. According to SDT, most reasons (90%) were regulated by autonomous motivation (either extrinsically autonomously-regulated or intrinsic motivation) and stemmed mostly from health-related goals (e.g., fitness, general health, weight control), future quality-of-life aspirations (e.g., self-sufficiency in old age, presence for loved ones, preserving mobility) and enjoyment of PA. Patients' responses underscore the importance of promoting not only general PA, but also muscle strengthening training in CR interventions to maximise optimal health benefits. Our data further suggest that interventions which are aligned to patients' health goals and foster autonomous motivation may be particularly beneficial in increasing adherence to PA in the long-term.
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Affiliation(s)
- Hannah McGowan
- Ludwig Boltzmann Institute for Digital Health and Prevention, Salzburg, Austria
| | - Johanna Gutenberg
- Ludwig Boltzmann Institute for Digital Health and Prevention, Salzburg, Austria
- Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Veronika Leitner
- Ludwig Boltzmann Institute for Digital Health and Prevention, Salzburg, Austria
| | - Kathrin Mühlhauser
- Ludwig Boltzmann Institute for Digital Health and Prevention, Salzburg, Austria
| | | | - Michael Fischer
- VAMED Rehabilitation Center Kitzbühel, Kitzbühel, Austria
- Ludwig Boltzmann Institute for Rehabilitation Research, Wien, Austria
| | | | - Vincent Grote
- Ludwig Boltzmann Institute for Rehabilitation Research, Wien, Austria
| | - David Kiesl
- CARDIOMED Cardiac Rehabilitation Center, Linz, Austria
- Department of Internal Medicine I for Hematology with Stem Cell Transplantation, Hemostaseology and Medical Oncology, Ordensklinikum Linz Elisabethinen, Linz, Austria
- Medical Faculty, Johannes Kepler University Linz, Linz, Austria
| | - Karl Mayr
- CARDIOMED Cardiac Rehabilitation Center, Linz, Austria
| | | | - Andrea Podolsky
- Institute of Preventive and Applied Sports Medicine, University Hospital Krems, Karl Landsteiner University of Health Sciences, Krems, Austria
| | - Josef Niebauer
- Ludwig Boltzmann Institute for Digital Health and Prevention, Salzburg, Austria
- University Institute of Sports Medicine, Prevention and Rehabilitation and Research Institute of Molecular Sports Medicine and Rehabilitation, Paracelsus Medical University, Salzburg, Austria
| | - Rik Crutzen
- Ludwig Boltzmann Institute for Digital Health and Prevention, Salzburg, Austria
- Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Stefan Tino Kulnik
- Ludwig Boltzmann Institute for Digital Health and Prevention, Salzburg, Austria
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Ratz M, Vogel JB, Kührer H, Säly CH, Mündlein A, Vonbank A, Mader A, Fraunberger P, Leiherer A, Drexel H. 25 years of lipid-lowering therapy: secular trends in therapy of coronary patients. Wien Klin Wochenschr 2024:10.1007/s00508-024-02365-x. [PMID: 38743139 DOI: 10.1007/s00508-024-02365-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 04/05/2024] [Indexed: 05/16/2024]
Abstract
BACKGROUND AND AIM Guidelines on dyslipidemia and lipid-lowering therapy (LLT) over the years recommend lower low-density lipoprotein cholesterol (LDL-C) goals by more intense therapy. Nevertheless, LDL‑C has increased in the general population. Real-world trends of LLT medication as well as of LDL‑C levels in cardiovascular high-risk patients are unclear. METHODS From 2158 patients who were referred for elective coronary angiography, lipid medication was analyzed at admission in three cardiovascular observational studies (OS) over the last 25 years: OS1: 1999-2000, OS2: 2005-2008 and OS3: 2022-2023. The three studies were performed at the same cardiology unit of a tertiary care hospital in Austria. RESULTS The proportion of patients without LLT significantly decreased from OS1 through OS2 to OS3 (49.4%, 45.6%, and 18.5%, respectively, ptrend < 0.001). Moreover, the percentage of patients under high-intensity statin treatment significantly increased from 0% to 5.1%, and 56.5% (ptrend < 0.001). Significantly more patients became treated by more than one compound (OS1: 1.8%, OS2: 1.6%, OS3: 31.2%; ptrend < 0.001). In the latest OS3, a trend to fixed-dose combination of statins with ezetimibe was observed. Mean LDL‑C levels decreased from 129 mg/dL over 127 mg/dL to 83 mg/dL, respectively (ptrend < 0.001). Of the patients on high-intensity therapy 34% met the recent ESC/EAS goals (LDL-C < 55 mg/dL), but only 3% on non-intense therapy. CONCLUSION We conclude that during the observational period of a quarter of a century, treatment intensity increased and LDL‑C levels improved considerably. Guidelines apparently matter in this high-risk population and are considered by primary care physicians.
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Affiliation(s)
- Magdalena Ratz
- Private University in the Principality of Liechtenstein (UFL), Triesen, Liechtenstein
- Vorarlberg Institute for Vascular Investigation & Treatment, (VIVIT), Carinagasse 47, 6800, Feldkirch, Austria
| | - Johannes B Vogel
- Private University in the Principality of Liechtenstein (UFL), Triesen, Liechtenstein
- Vorarlberg Institute for Vascular Investigation & Treatment, (VIVIT), Carinagasse 47, 6800, Feldkirch, Austria
| | - Heike Kührer
- Vorarlberg Institute for Vascular Investigation & Treatment, (VIVIT), Carinagasse 47, 6800, Feldkirch, Austria
| | - Christoph H Säly
- Private University in the Principality of Liechtenstein (UFL), Triesen, Liechtenstein
- Vorarlberg Institute for Vascular Investigation & Treatment, (VIVIT), Carinagasse 47, 6800, Feldkirch, Austria
- Department of Internal Medicine I, Academic Teaching Hospital Feldkirch, Feldkirch, Austria
| | - Axel Mündlein
- Vorarlberg Institute for Vascular Investigation & Treatment, (VIVIT), Carinagasse 47, 6800, Feldkirch, Austria
| | - Alexander Vonbank
- Private University in the Principality of Liechtenstein (UFL), Triesen, Liechtenstein
- Vorarlberg Institute for Vascular Investigation & Treatment, (VIVIT), Carinagasse 47, 6800, Feldkirch, Austria
- Department of Internal Medicine I, Academic Teaching Hospital Feldkirch, Feldkirch, Austria
| | - Arthur Mader
- Vorarlberg Institute for Vascular Investigation & Treatment, (VIVIT), Carinagasse 47, 6800, Feldkirch, Austria
- Department of Internal Medicine I, Academic Teaching Hospital Feldkirch, Feldkirch, Austria
| | - Peter Fraunberger
- Private University in the Principality of Liechtenstein (UFL), Triesen, Liechtenstein
- Central Medical Laboratories, Feldkirch, Austria
| | - Andreas Leiherer
- Private University in the Principality of Liechtenstein (UFL), Triesen, Liechtenstein.
- Vorarlberg Institute for Vascular Investigation & Treatment, (VIVIT), Carinagasse 47, 6800, Feldkirch, Austria.
- Central Medical Laboratories, Feldkirch, Austria.
| | - Heinz Drexel
- Private University in the Principality of Liechtenstein (UFL), Triesen, Liechtenstein.
- Vorarlberg Institute for Vascular Investigation & Treatment, (VIVIT), Carinagasse 47, 6800, Feldkirch, Austria.
- Landeskrankenhausbetriebsgesellschaft, Academic Teaching Hospital Feldkirch, Feldkirch, Austria.
- Drexel University College of Medicine, Philadelphia, PA, USA.
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Bentzel S, Ljungman C, Hjerpe P, Schiöler L, Manhem K, Bengtsson Boström K, Kahan T, Mourtzinis G. Long-term secondary prevention and outcome following acute coronary syndrome: real-world results from the Swedish Primary Care Cardiovascular Database. Eur J Prev Cardiol 2024; 31:812-821. [PMID: 38135289 DOI: 10.1093/eurjpc/zwad389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Revised: 12/01/2023] [Accepted: 12/11/2023] [Indexed: 12/24/2023]
Abstract
AIMS Most studies of treatment adherence after acute coronary syndrome (ACS) are based on prescribed drugs and lack long-term follow-up or consecutive data on risk factor control. We studied the long-term treatment adherence, risk factor control, and its association to recurrent ACS and death. METHODS AND RESULTS We retrospectively included 3765 patients (mean age 75 years, 40% women) with incident ACS from 1 January 2006 until 31 December 2010 from the Swedish Primary Care Cardiovascular Database of Skaraborg. All patients were followed until 31 December 2014 or death. We recorded blood pressure (BP), low-density lipoprotein cholesterol (LDL-C), recurrent ACS, and death. We used data on dispensed drugs to calculate the proportion of days covered for secondary prevention medications. Cox regressions were used to analyse the association of achieved BP and LDL-C to recurrent ACS and death. The median follow-up time was 4.8 years. The proportion of patients that reached BP of <140/90 mm Hg was 58% at Year 1 and 66% at Year 8. 65% of the patients reached LDL-C of <2.5 mmol/L at Year 1 and 56% at Year 8; however, adherence to statins varied from 43% to 60%. Only 62% of the patients had yearly measured BP, and only 28% yearly measured LDL-C. Systolic BP was not associated with a higher risk of recurrent ACS or death. Low-density lipoprotein cholesterol of 3.0 mmol/L was associated with a higher risk of recurrent ACS {hazard ratio [HR] 1.19 [95% confidence interval (CI) 1.00-1.40]} and death HR [1.26 (95% CI 1.08-1.47)] compared with an LDL-C of 1.8 mmol/L. CONCLUSION This observational long-term real-world study demonstrates low drug adherence and potential for improvement of risk factors after ACS. Furthermore, the study confirms that uncontrolled LDL-C is associated with adverse outcome even in this older population.
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Affiliation(s)
- Sara Bentzel
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Blå stråket 5B Wallenberglab/SU, 413 45, Gothenburg, Sweden
- Department of Cardiology, Sahlgrenska University Hospital, Blå stråket 3, 413 46, Gothenburg, Sweden
| | - Charlotta Ljungman
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Blå stråket 5B Wallenberglab/SU, 413 45, Gothenburg, Sweden
- Department of Cardiology, Sahlgrenska University Hospital, Blå stråket 3, 413 46, Gothenburg, Sweden
| | - Per Hjerpe
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Regionhälsan R&D Centre, Skaraborg Primary Care, Skövde, Sweden
| | - Linus Schiöler
- Occupational and Environmental Medicine, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Karin Manhem
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Kristina Bengtsson Boström
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Regionhälsan R&D Centre, Skaraborg Primary Care, Skövde, Sweden
| | - Thomas Kahan
- Division of Cardiovascular Medicine, Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Georgios Mourtzinis
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Blå stråket 5B Wallenberglab/SU, 413 45, Gothenburg, Sweden
- Department of Medicine and Emergency Mölndal, Sahlgrenska University Hospital, Mölndal, Sweden
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5
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Rallidis LS, Papathanasiou KA, Tsamoulis D, Bouratzis V, Leventis I, Kalantzis C, Malkots B, Kalogeras P, Tasoulas D, Delakis I, Lykoudis A, Daios S, Potoupni V, Zervakis S, Theofilatos A, Kotrotsios G, Kostakou PM, Kostopoulos K, Gounopoulos P, Mplani V, Zacharis E, Barmpatzas N, Kotsakis A, Papadopoulos C, Trikas A, Ziakas A, Skoularigis I, Naka KK, Tziakas D, Panagiotakos D, Vlachopoulos C. Newly detected diabetes mellitus patients with acute coronary syndrome have an adverse cardiometabolic profile similar to patients with prior diabetes and a more extensive ischemic myocardial insult. Diabetes Res Clin Pract 2024; 211:111664. [PMID: 38604446 DOI: 10.1016/j.diabres.2024.111664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Revised: 03/12/2024] [Accepted: 04/08/2024] [Indexed: 04/13/2024]
Abstract
AIMS The impact of newly detected diabetes mellitus (NDDM) on metabolic parameters and extent of myocardial necrosis in patients with acute coronary syndrome (ACS) is not fully explored. We examined the impact of NDDM on cardiometabolic characteristics and myocardial necrosis in ACS patients. METHODS CALLINICUS-Hellas Registry is an ongoing prospective multicenter observational study evaluating the adherence to lipid-lowering therapy (LLT) among ACS patients in Greece. Three groups were created: a) patients with NDDM (abnormal fasting glucose, HbA1c ≥ 6.5 % and no previous history of DM), b) patients without known DM and HbA1c < 6.5 % (non-DM) and c) patients with prior DM. RESULTS The prevalence of NDDM among 1084 patients was 6.9 %. NDDM patients had lower HDL-C [38 (32-45) vs 42 (36-50) mg/dL] and higher triglycerides levels [144 (104-231) vs 115 (87-152) mg/dL] compared to non-DM patients (p < 0.05). NDDM patients featured both higher body mass index [29.5 (26.4-34.3) vs 27.1 (24.9-29.9) kg/m2] and waist circumference [107 (100-114) vs 98 (91-106) cm] compared to non-DM patients (p < 0.05). In addition, NDDM patients had more extensive myocardial necrosis than patients with prior DM. CONCLUSIONS ACS patients with NDDM have an adverse cardiometabolic profile similar to patients with prior DM and have more extensive myocardial insult.
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Affiliation(s)
- Loukianos S Rallidis
- 2nd Department of Cardiology, Medical School, National and Kapodistrian University of Athens, University General Hospital ATTIKON, Athens, Greece
| | - Konstantinos A Papathanasiou
- 2nd Department of Cardiology, Medical School, National and Kapodistrian University of Athens, University General Hospital ATTIKON, Athens, Greece.
| | | | - Vasileios Bouratzis
- Second Department of Cardiology, University Hospital of Ioannina, Ioannina, Greece
| | - Ioannis Leventis
- Department of Cardiology, University General Hospital of Larissa, Larissa, Greece
| | - Charalampos Kalantzis
- 1st Department of Cardiology, Medical School, National and Kapodistrian, University of Athens, Hippokration Hospital, Athens, Greece
| | - Belkis Malkots
- Cardiology Department, Medical School, Democritus University of Thrace, Dragana, Alexandroupolis, Greece
| | - Petros Kalogeras
- Second Department of Cardiology, University Hospital of Ioannina, Ioannina, Greece
| | - Dimitrios Tasoulas
- 2nd Department of Cardiology, General Hospital of Nikea, Piraeus, Greece
| | - Iosif Delakis
- 1st Department of Cardiology, General Hospital of Nikea, Piraeus, Greece
| | - Anastasios Lykoudis
- 2nd Department of Cardiology, General Hospital of Athens "Evangelismos", Athens, Greece
| | - Stylianos Daios
- 1st Department of Cardiology, University General Hospital of Thessaloniki, AHEPA, Thessaloniki, Greece
| | - Victoria Potoupni
- 3rd Cardiology Department, Hippokration University Hospital, Aristotle University, Thessaloniki, Greece
| | - Stelios Zervakis
- Cardiology Department, Heraklion University Hospital, Crete, Greece
| | | | - Georgios Kotrotsios
- 2nd Department of Cardiology, Medical School, National and Kapodistrian University of Athens, University General Hospital ATTIKON, Athens, Greece
| | - Peggy M Kostakou
- Department of Clinical Therapeutics, University of Athens, Alexandra Hospital, Athens, Greece
| | | | - Pantelis Gounopoulos
- 2nd Department of Cardiology, General Hospital of Athens "Evangelismos", Athens, Greece
| | - Virginia Mplani
- Department of Cardiology, Patras University Hospital, Patras, Greece
| | | | | | | | | | | | - Antonios Ziakas
- 1st Department of Cardiology, University General Hospital of Thessaloniki, AHEPA, Thessaloniki, Greece
| | - Ioannis Skoularigis
- Department of Cardiology, University General Hospital of Larissa, Larissa, Greece
| | - Katerina K Naka
- Second Department of Cardiology, University Hospital of Ioannina, Ioannina, Greece
| | - Dimitrios Tziakas
- Cardiology Department, Medical School, Democritus University of Thrace, Dragana, Alexandroupolis, Greece
| | | | - Charalambos Vlachopoulos
- 1st Department of Cardiology, Medical School, National and Kapodistrian, University of Athens, Hippokration Hospital, Athens, Greece
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Chen C, Zheng Y, Wu Y, Zheng K, Wang Y, Huang C, Guo J, Qi Y, Chen X, Tao Q, Zhai J, Han P, Pan Y, Guo Q. The association between time-restricted eating and arterial stiffness status in community-dwelling elderly Chinese individuals. Nutr Metab Cardiovasc Dis 2024; 34:1217-1225. [PMID: 38418352 DOI: 10.1016/j.numecd.2024.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 08/31/2023] [Accepted: 09/21/2023] [Indexed: 03/01/2024]
Abstract
BACKGROUND AND AIMS Emerging studies indicate that time-restricted eating (TRE) may protect against cardiovascular disease (CVD); however, studies performed in elderly adults are limited. This study aimed to analyze the association of TRE with arterial stiffness (AS) in community-dwelling elderly Chinese individuals. METHODS AND RESULTS This cross-sectional study recruited 3487 participants aged ≥60 y from Shanghai, China. TRE was determined by calculating the end time of the last meal minus the start time of the first meal of the average day. Participants were then categorized into those with a time-restricted window lasting ≤11 h (TRE) and >11 h (non-TRE). The mean age of the sample was 71.78 ± 5.75 y, and 41.2 % were men. Having a TRE pattern was 72.2 %. In the logistic analysis, TRE was associated with borderline arterial stiffness (OR = 1.419; 95 % CI = 1.077-1.869) and elevated arterial stiffness (OR = 1.699; 95 % CI = 1.276-2.263). In a subgroup analysis, the significance remained in the group at risk of malnutrition (with borderline arterial stiffness: OR = 2.270; 95 % CI = 1.229-4.190; with elevated arterial stiffness: OR = 2.459; 95 % CI = 1.287-4.700), while in well-nourished participants, the association only remained with elevated arterial stiffness (OR = 1.530; 95 % CI = 1.107-2.115) and not with borderline arterial stiffness. CONCLUSIONS TRE is a risk factor for both borderline and elevated arterial stiffness in community-dwelling Chinese individuals and varies by nutritional status. (Protocol code 2019-WJWXM-04-310108196508064467.).
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Affiliation(s)
- Cheng Chen
- School of Health, Fujian Medical University, Fujian, China; College of Rehabilitation Sciences, Shanghai University of Medicine and Health Sciences, Shanghai, China
| | | | - Yahui Wu
- College of Rehabilitation Sciences, Shanghai University of Medicine and Health Sciences, Shanghai, China; School of Health Science and Engineering, University of Shanghai for Science and Technology, Shanghai, China
| | - Kai Zheng
- College of Rehabilitation Sciences, Shanghai University of Medicine and Health Sciences, Shanghai, China; School of Health Science and Engineering, University of Shanghai for Science and Technology, Shanghai, China
| | - Yue Wang
- College of Rehabilitation Sciences, Shanghai University of Medicine and Health Sciences, Shanghai, China; School of Health Science and Engineering, University of Shanghai for Science and Technology, Shanghai, China
| | - Chuanjun Huang
- College of Rehabilitation Sciences, Shanghai University of Medicine and Health Sciences, Shanghai, China; School of Health Science and Engineering, University of Shanghai for Science and Technology, Shanghai, China
| | - Jiangling Guo
- College of Rehabilitation Sciences, Shanghai University of Medicine and Health Sciences, Shanghai, China; Graduate School, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Yiqiong Qi
- College of Rehabilitation Sciences, Shanghai University of Medicine and Health Sciences, Shanghai, China; Department of Sport Rehabilitation, Shanghai University of Sport, Shanghai, China
| | - Xiaoyu Chen
- College of Rehabilitation Sciences, Shanghai University of Medicine and Health Sciences, Shanghai, China
| | - Qiongying Tao
- Jiading Subdistrict Community Health Center, Shanghai, China
| | - Jiayi Zhai
- Jiading Subdistrict Community Health Center, Shanghai, China
| | - Peipei Han
- College of Rehabilitation Sciences, Shanghai University of Medicine and Health Sciences, Shanghai, China.
| | - Yanxia Pan
- School of Health, Fujian Medical University, Fujian, China.
| | - Qi Guo
- School of Health, Fujian Medical University, Fujian, China; Department of Rehabilitation Medicine, Shanghai University of Medicine and Health Sciences Affiliated Zhoupu Hospital, Shanghai, China.
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7
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Coca A, Whelton SP, Camafort M, López-López JP, Yang E. Single-pill combination for treatment of hypertension: Just a matter of practicality or is there a real clinical benefit? Eur J Intern Med 2024:S0953-6205(24)00172-9. [PMID: 38653633 DOI: 10.1016/j.ejim.2024.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2024] [Revised: 03/27/2024] [Accepted: 04/16/2024] [Indexed: 04/25/2024]
Abstract
Elevated blood pressure (BP) is the largest contributor to the incident cardiovascular disease worldwide. Despite explicit guideline recommendations for the diagnosis and management of hypertension, a large proportion of patients remain undiagnosed, untreated, or treated but uncontrolled. Inadequate BP control is associated with many complex factors including patient preference, physician's inertia, health systems disparities, and poor adherence to prescribed antihypertensive drug treatment. The primary driver for reduced cardiovascular morbidity and mortality is lowering of BP ''per se'' and not class effects of specific pharmacotherapies. The recent ESH guidelines recommend the use of four major classes of drugs including renin-angiotensin-aldosterone system (RAS) blockers (angiotensin receptor blockers (ARB) or angiotensin-converting enzyme inhibitors (ACEi)), calcium channel blockers (CCB), thiazide and thiazide-like diuretics, and betablockers. Initiation of treatment for hypertension with a two-drug regimen, preferably in a single pill combination (SPC), is recommended for most patients. Preferred combinations should comprise a RAS blocker (either an ACEi or an ARB) with a CCB or thiazide/thiazide-like diuretic. These strategies are supported by robust evidence that combination therapy produces greater BP reductions than monotherapy, reduces side effects of the individual components, improves therapeutic adherence and long-term persistence on treatment, and permits achievement of earlier BP control.
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Affiliation(s)
- A Coca
- Hypertension and Vascular Risk Unit. Department of Internal Medicine. Hospital Clínic, University of Barcelona, Barcelona, Spain.
| | - S P Whelton
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - M Camafort
- Hypertension and Vascular Risk Unit. Department of Internal Medicine. Hospital Clínic (IDIBAPS, CIBER-OBN). University of Barcelona, Barcelona, Spain
| | - J P López-López
- Masira Research Institute, University of Santander (UDES), Bucaramanga, Colombia
| | - E Yang
- Division of Cardiology, University of Washington School of Medicine, Seattle, Washington, USA
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8
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Rakers M, van Hattem N, Simic I, Chavannes N, van Peet P, Bonten T, Vos R, van Os H. Tailoring remote patient management in cardiovascular risk management for healthcare professionals using panel management: a qualitative study. BMC Prim Care 2024; 25:122. [PMID: 38643103 PMCID: PMC11031879 DOI: 10.1186/s12875-024-02355-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 03/28/2024] [Indexed: 04/22/2024]
Abstract
BACKGROUND While remote patient management (RPM) has the potential to assist in achieving treatment targets for cardiovascular risk factors in primary care, its effectiveness may vary among different patient subgroups. Panel management, which involves proactive care for specific patient risk groups, could offer a promising approach to tailor RPM to these groups. This study aims to (i) assess the perception of healthcare professionals and other stakeholders regarding the adoption and (ii) identify the barriers and facilitators for successfully implementing such a panel management approach. METHODS In total, nineteen semi-structured interviews and two focus groups were conducted in the Netherlands. Three authors reviewed the audited transcripts. The Consolidated Framework for Implementation Strategies (CFIR) domains were used for the thematic analysis. RESULTS A total of 24 participants (GPs, nurses, health insurers, project managers, and IT consultants) participated. Overall, a panel management approach to RPM in primary care was considered valuable by various stakeholders. Implementation barriers encompassed concerns about missing necessary risk factors for patient stratification, additional clinical and technical tasks for nurses, and reimbursement agreements. Facilitators included tailoring consultation frequency and early detection of at-risk patients, an implementation manager accountable for supervising project procedures and establishing agreements on assessing implementation metrics, and ambassador roles. CONCLUSION Panel management could enhance proactive care and accurately identify which patients could benefit most from RPM to mitigate CVD risk. For successful implementation, we recommend having clear agreements on technical support, financial infrastructure and the criteria for measuring evaluation outcomes.
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Affiliation(s)
- Margot Rakers
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, 2333 ZA, The Netherlands.
| | - Nicoline van Hattem
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, 2333 ZA, The Netherlands
| | - Iris Simic
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, 2333 ZA, The Netherlands
| | - Niels Chavannes
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, 2333 ZA, The Netherlands
| | - Petra van Peet
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, 2333 ZA, The Netherlands
| | - Tobias Bonten
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, 2333 ZA, The Netherlands
| | - Rimke Vos
- Health Campus the Hague, Leiden University Medical Center, The Hague, 2511 DP, The Netherlands
| | - Hendrikus van Os
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, 2333 ZA, The Netherlands
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9
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Ghali H, El Hraiech A, Ben Souda H, Karray M, Pavy B, Zedini C. Therapeutic education of patients with coronary heart disease: Impact of digital platform monitoring in preventing major cardiovascular events in Tunisia: Study protocol. PLoS One 2024; 19:e0300250. [PMID: 38635687 PMCID: PMC11025886 DOI: 10.1371/journal.pone.0300250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 02/18/2024] [Indexed: 04/20/2024] Open
Abstract
BACKGROUND Faced with the increase in the number of chronic diseases with the aging of the population, and with the observation of the insufficiency of therapeutic control, a new need has emerged, that of having a patient as a partner in care. METHODS This study is a randomized controlled trial. Patients with coronary heart disease will be recruited from one clinical site and randomly assigned into two groups: the intervention group and the control group. All participants will be followed up for a total of one year (with three-time points for data collection). Patients who are assigned to the intervention group will receive therapeutic education at first. The digital platform will then allow healthcare providers to accompany them outside the hospital walls. The primary outcome is the incidence of major cardiovascular events within one year of discharge. Main secondary outcomes include changes in health behaviors, medication adherence, and quality of life score. The digital platform is a multi-professional telemonitoring platform that allows care teams to accompany the patient outside the hospital walls. It allows the collection and transmits information from the patient's home to the therapeutic education team. All data will be secured at a certified host. The patient application provides data on compliance, adherence to physical activity (number of steps taken per day), adequate diet (weight gain, food consumed during the meal, compliance with low-salt or salt-free diet, diabetic diet), smoking cessation, as well as medication adherence. Access to educational tools (digital media) is provided to all initial program participants. These tools will be updated annually by the rehabilitation team on the recommendations. The platform also offers the possibility of organizing an individual or group remote educational session (videoconference modules allowing group and individual sessions), a secure integrated caregiver-patient messaging system. The control group will receive the usual controls at the hospital. DISCUSSION To offer a complete solution of care to our patients, we have thought of setting up a digital platform that aims to monitor the patient and strengthen their abilities to manage their condition daily. This pilot experience could be generalized to several services and disciplines. It could be used in several research works. TRIAL REGISTRATION Trial registered with the Pan African Clinical Trial Registry (PACTR202307694422939). URL: https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=24247.
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Affiliation(s)
- Hela Ghali
- Faculty of Medicine of Sousse, University of Sousse, Sousse, Tunisia
- Department of Prevention and Security of Care, Sahloul University Hospital, Sousse, Tunisia
| | - Aymen El Hraiech
- Faculty of Medicine of Sousse, University of Sousse, Sousse, Tunisia
- Department of Cardiology, Sahloul University Hospital, Sousse, Tunisia
| | - Hend Ben Souda
- Family Medicine, Faculty of Medicine of Sousse, Sousse, Tunisia
| | - Majdi Karray
- Faculty of Pharmacy of Monastir, University of Monastir, Monastir, Tunisia
| | - Bruno Pavy
- Cardiac Rehabilitation Department, Loire-Vendée-Océan Hospital Center, Machecoul, France
| | - Chekib Zedini
- Faculty of Medicine of Sousse, University of Sousse, Sousse, Tunisia
- Department of Family and Community Medicine, Faculty of Medicine of Sousse, Sousse, Tunisia
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Grave C, Gabet A, Iliou MC, Cinaud A, Tuppin P, Blacher J, Olié V. Temporal trends in admission for cardiac rehabilitation after an acute coronary syndrome in France from 2009 to 2021: Persistent sex, age and social disparities. Arch Cardiovasc Dis 2024; 117:234-243. [PMID: 38458957 DOI: 10.1016/j.acvd.2023.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 12/17/2023] [Accepted: 12/19/2023] [Indexed: 03/10/2024]
Abstract
BACKGROUND Cardiac rehabilitation after an acute coronary syndrome is recommended to decrease patient morbidity and mortality and to improve quality of life. AIMS To describe time trends in the rates of patients undergoing cardiac rehabilitation after an acute coronary syndrome in France from 2009 to 2021, and to identify possible disparities. METHODS All patients hospitalized for acute coronary syndrome in France between January 2009 and June 2021 were identified from the national health insurance database. Cardiac rehabilitation attendance was identified within 6 months of acute coronary syndrome hospital discharge. Age-standardized cardiac rehabilitation rates were computed and stratified for sex and acute coronary syndrome subtypes (ST-segment elevation and non-ST-segment elevation). Patient characteristics and outcomes were described and compared. Factors independently associated with cardiac rehabilitation attendance were identified. RESULTS In 2019, among 134,846 patients with an acute coronary syndrome, 22.3% underwent cardiac rehabilitation within 6 months of acute coronary syndrome hospital discharge. The mean age of patients receiving cardiac rehabilitation was 62 years. The median delay between acute coronary syndrome hospitalization and cardiac rehabilitation was 32 days, with about 60% receiving outpatient cardiac rehabilitation. Factors significantly associated with higher cardiac rehabilitation rates were male sex, younger age (35-64 years), least socially disadvantaged group, ST-segment elevation, percutaneous coronary intervention and coronary artery bypass graft. Between 2009 and 2019, cardiac rehabilitation rates increased by 40% from 15.9% to 22.3%. Despite greater upward trends in women, their cardiac rehabilitation rate was significantly lower than that for men (14.8% vs. 25.8%). In 2020, cardiac rehabilitation attendance dropped because of the coronavirus disease 2019 pandemic. CONCLUSIONS Despite the health benefits of cardiac rehabilitation, current cardiac rehabilitation attendance after acute coronary syndrome remains insufficient in France, particularly among the elderly, women and socially disadvantaged people.
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Affiliation(s)
- Clémence Grave
- Surveillance des maladies cardio-neuro-vasculaires, direction des maladies non transmissibles, Santé Publique France, 94415 Saint-Maurice, France.
| | - Amélie Gabet
- Surveillance des maladies cardio-neuro-vasculaires, direction des maladies non transmissibles, Santé Publique France, 94415 Saint-Maurice, France
| | | | - Alexandre Cinaud
- Centre de diagnostic et de thérapeutique, université Paris-Cité, Hôpital Hôtel-Dieu, AP-HP, 75004 Paris, France
| | - Philippe Tuppin
- Direction de la stratégie, des études et des statistiques, Caisse Nationale de l'Assurance Maladie, 75020 Paris, France
| | - Jacques Blacher
- Centre de diagnostic et de thérapeutique, université Paris-Cité, Hôpital Hôtel-Dieu, AP-HP, 75004 Paris, France
| | - Valérie Olié
- Surveillance des maladies cardio-neuro-vasculaires, direction des maladies non transmissibles, Santé Publique France, 94415 Saint-Maurice, France
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11
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van Trier TJ, Jørstad HT, Scholte Op Reimer WJM, Sunamura M, Ter Hoeve N, Aernout Somsen G, Peters RJG, Snaterse M. Patients' preferences for secondary prevention following a coronary event. Prev Med Rep 2024; 40:102681. [PMID: 38495768 PMCID: PMC10940170 DOI: 10.1016/j.pmedr.2024.102681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 03/05/2024] [Accepted: 03/06/2024] [Indexed: 03/19/2024] Open
Abstract
Objective Despite clear evidence on the effectiveness of secondary prevention, patients with coronary artery disease frequently fail to reach guideline-based risk factor targets. Integrating patients' preferences into treatment decisions has been recommended to reduce this gap. However, this requires knowledge about patient treatment preferences. Therefore, through a survey study, we aimed to explore which risk factors patients self-perceived, prioritised for improvement, and needed support with after a recent hospitalisation for coronary heart disease. Methods A digital questionnaire was presented to patients > 18 years recently discharged (≤3 months) from an acute coronary care unit in the Netherlands (Europe). Patients could select from eight cardiovascular risk factors that they (1) self-perceived, (2) prioritised for improvement, and (3) needed support to improve. Patients' perceived risk factors were compared to those documented in the medical records. Results Respondents (N = 254, 26 % women), mean age 64 (SD 10) years, identified 'physical inactivity' more frequently than their medical records (140 patients vs. 91 records, p < 0.001), while three other risk factors were reported with equal and four with lower frequency. 'Physical inactivity', 'overweight' and 'stress' were most frequently prioritised for improvement (82 %, 88 % and 78 %) and professional support (64 %, 50 % and 58 %), with 87 % preferring lifestyle optimisation if this would reduce drug use. Conclusions Patients with a recent coronary event show significant disparities in identifying risk factors compared to their medical records. They tend to prefer improving lifestyle- over drug-modifiable risk factors, particularly physical inactivity, overweight and stress, and indicate the need for support in improving these factors.
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Affiliation(s)
- Tinka J van Trier
- Department of Cardiology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Harald T Jørstad
- Department of Cardiology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Wilma J M Scholte Op Reimer
- Department of Cardiology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
- Research Group Chronic Diseases, HU University of Applied Sciences Utrecht, Utrecht, The Netherlands
| | - Madoka Sunamura
- Capri Cardiac Rehabilitation Rotterdam, Rotterdam, The Netherlands
- Franciscus Gasthuis & Vlietland Hospital, Rotterdam, The Netherlands
| | - Nienke Ter Hoeve
- Capri Cardiac Rehabilitation Rotterdam, Rotterdam, The Netherlands
- Department of Rehabilitation Medicine, Erasmus MC Medical Center, Rotterdam, The Netherlands
| | - G Aernout Somsen
- Cardiology Centers of the Netherlands, Amsterdam, The Netherlands
| | - Ron J G Peters
- Department of Cardiology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Marjolein Snaterse
- Department of Cardiology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
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Vilela EM, Bento L, Oliveira L, Abreu A, Dores H, Teixeira M, Mendes M, Fontes P, Fontes-Carvalho R, Pereira H, Gonçalves L. Training and attitudes concerning cardiac rehabilitation in Portugal: A national survey of physician members of the Portuguese Society of Cardiology. Rev Port Cardiol 2024:S0870-2551(24)00074-X. [PMID: 38460749 DOI: 10.1016/j.repc.2023.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Accepted: 12/22/2023] [Indexed: 03/11/2024] Open
Abstract
INTRODUCTION AND OBJECTIVES Cardiac rehabilitation (CR) is a central component in the management of cardiovascular disease. While its potential benefits have been extensively explored and confirmed, its implementation is still suboptimal, due to various possible barriers. This study aimed to assess training and attitudes concerning CR among physicians in a Portuguese setting. METHODS An online questionnaire structured in three parts (participant characteristics, training and attitudes concerning CR, and a brief general knowledge assessment) was developed and sent to members of the Portuguese Society of Cardiology. The study population encompassed physicians with a medical specialty or residents from the third year onward of a specialty program. RESULTS A total of 97 individuals (57.7% male, 61.9% aged ≤50 years) presented valid answers. CR was available at the workplace of 54.6% of participants. Most of them considered that the time allocated to CR training during residency was inadequate, and thought that more time was needed for this purpose. Most had not dedicated (or intended to dedicate) time for CR training, with lack of time being the most frequently attributed reason. In terms of referral, a substantial proportion of subjects did not refer patients, with lack of CR centers and human resources being the most frequent reasons. CONCLUSIONS This survey provides contemporary data on CR training and attitudes, highlighting areas of potential improvement, such as time allocated to training in this area. These results could provide a useful pragmatic framework for optimization of training and awareness in this pivotal field of cardiovascular medicine.
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Affiliation(s)
- Eduardo M Vilela
- Cardiology Department, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal.
| | - Luísa Bento
- Cardiology Department, Hospital Garcia de Orta, Portugal
| | - Luís Oliveira
- Cardiology Department, Centro Hospitalar Universitário Cova da Beira, Covilhã, Portugal
| | - Ana Abreu
- Serviço de Cardiologia, Hospital Universitário de Santa Maria/Centro Hospitalar Universitário Lisboa Norte (CHULN), Lisboa, Portugal; Centro Académico de Medicina de Lisboa (CAML), Centro Cardiovascular da Universidade de Lisboa (CCUL), Lisboa, Portugal; Instituto de Saúde Ambiental (ISAMB), Instituto Medicina Preventiva e Saúde Pública (IMPSP), Instituto de Medicina Nuclear (IMN), Faculdade de Medicina da Universidade de Lisboa (FMUL), Lisboa, Portugal
| | - Hélder Dores
- Cardiology Department, Hospital da Luz, Lisboa, Portugal; NOVA Medical School, Faculdade de Ciências Médicas, NMS|FCM, Universidade Nova de Lisboa, Lisbon, Portugal; CHRC, NOVA Medical School, Faculdade de Ciências Médicas, NMS|FCM, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Madalena Teixeira
- Cardiology Department, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - Miguel Mendes
- Cardiology Department, Centro Hospitalar de Lisboa Ocidental - Hospital de Santa Cruz, Carnaxide, Portugal
| | - Paulo Fontes
- Cardiology Department, Centro Hospitalar de Trás-os-Montes e Alto Douro, Vila Real, Portugal
| | - Ricardo Fontes-Carvalho
- Cardiology Department, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal; Cardiovascular Research Center (UniC@RISE), Faculty of Medicine, University of Porto, Porto, Portugal
| | - Hélder Pereira
- Cardiology Department, Hospital Garcia de Orta, Portugal; Faculty of Medicine, University of Lisbon, Lisboa, Portugal
| | - Lino Gonçalves
- Cardiology Department, Centro Hospitalar Universitário de Coimbra, Coimbra, Portugal; Faculty of Medicine, University of Coimbra, Coimbra, Portugal
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Cai S, Fu Y, Chen J, Tian M, Li X. Causal Relationship Between Branched-Chain Amino Acids and Hypertension: A Mendelian Randomization Study. J Am Heart Assoc 2024; 13:e032084. [PMID: 38420789 PMCID: PMC10944042 DOI: 10.1161/jaha.123.032084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Accepted: 01/12/2024] [Indexed: 03/02/2024]
Abstract
BACKGROUND This study aimed to investigate the causal relationships between branched-chain amino acids (BCAAs) and the risks of hypertension via meta-analysis and Mendelian randomization analysis. METHODS AND RESULTS A meta-analysis of 32 845 subjects was conducted to evaluate the relationships between BCAAs and hypertension. In Mendelian randomization analysis, independent single-nucleotide polymorphisms associated with BCAAs at the genome-wide significance level were selected as the instrumental variables. Meanwhile, the summary-level data for essential hypertension and secondary hypertension end points were obtained from the FinnGen study. As suggested by the meta-analysis results, elevated BCAA levels were associated with a higher risk of hypertension (isoleucine: summary odds ratio, 1.26 [95% CI, 1.08-1.47]; leucine: summary odds ratio, 1.28 [95% CI, 1.07-1.52]; valine: summary odds ratio, 1.32 [95% CI, 1.12-1.57]). Moreover, the inverse variance-weighted method demonstrated that an elevated circulating isoleucine level might be the causal risk factor for essential hypertension but not secondary hypertension (essential hypertension: odds ratio, 1.22 [95% CI, 1.12-1.34]; secondary hypertension: odds ratio, 0.96 [95% CI, 0.54-1.68]). CONCLUSIONS The increased levels of 3 BCAAs positively correlated with an increased risk of hypertension. Particularly, elevated isoleucine level is a causal risk factor for essential hypertension. Increased levels of leucine and valine also tend to increase the risk of essential hypertension, but further verification is still warranted.
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Affiliation(s)
- Shiyuan Cai
- School of Public Health, Shanghai Jiao Tong University School of MedicineShanghaiChina
| | - Yuanyuan Fu
- School of Public Health, Shanghai Jiao Tong University School of MedicineShanghaiChina
| | - Jie Chen
- School of Public Health, Shanghai Jiao Tong University School of MedicineShanghaiChina
| | - Mingjie Tian
- Department of Clinical Nutrition, Shanghai Deji HospitalAffiliated to Qingdao UniversityShanghaiChina
| | - Xue Li
- School of Public Health, Shanghai Jiao Tong University School of MedicineShanghaiChina
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14
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Zhou Y, Gao X, Xu J, Ding X, Yuan J, Du S, Shi X, Wang Y. Network analysis of perception of exercise benefits/barriers and kinesiophobia among patients with cardiovascular diseases. Heart Lung 2024; 64:182-188. [PMID: 38281371 DOI: 10.1016/j.hrtlng.2023.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 12/19/2023] [Accepted: 12/31/2023] [Indexed: 01/30/2024]
Abstract
BACKGROUND Perception of exercise benefits/barriers and kinesiophobia are important predictors of low exercise behaviors in patients with cardiovascular diseases (CVDs). Little is known about the complex intercorrelations between different components of perception of exercise benefits/barriers and kinesiophobia. OBJECTIVES To identify the central components of kinesiophobia and to explore the interconnectedness between perception of exercise benefits/barriers and kinesiophobia. METHODS A total of 258 patients with CVDs were recruited in this study. The Tampa Scale for Kinesiophobia Heart and the Exercise Benefits/Barriers Scale were used to assess kinesiophobia and perception of exercise benefits/barriers. R software was used to visualize the networks and analyze the centrality of the networks. The index "expected influence" and "bridge expected influence" were employed to identify the central components and the bridge components of the networks. RESULTS In the item network of kinesiophobia, three items ("It is really not safe for a person in my condition to be physically active/exercise", "I cannot do the same things as others because there is a too big risk that I will get heart problems", and "If I tried to be physically active/exercise my heart problem would increase") had the highest expected influence. In the exercise benefits/barriers-kinesiophobia network, the dimension of physical exertion had the highest positive bridge expected influence, while psychological outlook had highest negative value. CONCLUSIONS The three central components of kinesiophobia and the two bridge components (perception exercise barriers of physical exertion and perception exercise benefits of psychological outlook) should be targeted in specific intervention for relieving kinesiophobia and further promoting exercise behaviors.
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Affiliation(s)
- Yi Zhou
- School of Nursing, Hebei University, No.342 Yuhuadong Road, Lianchi District, Baoding, Hebei 071000, China
| | - Xiaopei Gao
- School of Nursing, Hebei University, No.342 Yuhuadong Road, Lianchi District, Baoding, Hebei 071000, China
| | - Jiangyuan Xu
- School of Nursing, Hebei University, No.342 Yuhuadong Road, Lianchi District, Baoding, Hebei 071000, China
| | - Xiaojuan Ding
- School of Nursing, Hebei University, No.342 Yuhuadong Road, Lianchi District, Baoding, Hebei 071000, China
| | - Jing Yuan
- School of Nursing, Hebei University, No.342 Yuhuadong Road, Lianchi District, Baoding, Hebei 071000, China
| | - Shaoying Du
- School of Nursing, Hebei University, No.342 Yuhuadong Road, Lianchi District, Baoding, Hebei 071000, China
| | - Xiaoyang Shi
- School of Nursing, Hebei University, No.342 Yuhuadong Road, Lianchi District, Baoding, Hebei 071000, China.
| | - Yan Wang
- School of Nursing, Hebei University, No.342 Yuhuadong Road, Lianchi District, Baoding, Hebei 071000, China.
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Dalmau R, Cordero A, Masana L, Ruiz E, Sicras-Mainar A, González-Juanatey JR. The CNIC-polypill (acetylsalicylic acid, atorvastatin, and ramipril), an effective and cost-saving secondary prevention strategy compared with other therapeutic options in patients with ischaemic heart disease. Eur Heart J Open 2024; 4:oeae027. [PMID: 38686352 PMCID: PMC11056486 DOI: 10.1093/ehjopen/oeae027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 02/14/2024] [Accepted: 02/26/2024] [Indexed: 05/02/2024]
Abstract
Aims The retrospective NEPTUNO study evaluated the effectiveness of the Centro Nacional de Investigaciones Cardiovasculares (CNIC)-polypill (including acetylsalicylic acid, ramipril, and atorvastatin) vs. other therapeutic approaches in secondary prevention for cardiovascular (CV) disease. In this substudy, the focus was on the subgroup of patients with ischaemic heart disease (IHD). Methods and results Patients on four strategies: CNIC-polypill, its monocomponents as loose medications, equipotent medications, and other therapies. The primary endpoint was the incidence of recurrent major adverse CV events (MACEs) after 2 years. After matching, 1080 patients were included in each cohort. The CNIC-polypill cohort had a significantly lower incidence of recurrent MACE compared with monocomponents, equipotent drugs, and other therapies cohorts (16.1 vs. 24, 24.4, and 24.3%, respectively; P < 0.001). The hazard ratios (HRs) for recurrent MACE were higher in monocomponents (HR = 1.12; P = 0.042), equipotent drugs (HR = 1.14; P = 0.031), and other therapies cohorts (HR = 1.17; P = 0.016) compared with the CNIC-polypill, with a number needed to treat of 12 patients to prevent a MACE. The CNIC-polypill demonstrated a greater reduction in LDL cholesterol (LDL-c; -56.1 vs. -43.6, -33.3, and -33.2% in the monocomponents, equipotent drugs, and other therapies, respectively; P < 0.001) and systolic blood pressure (-13.7 vs. -11.5, -10.6, and -9.1% in the CNIC-polypill, monocomponents, equipotent drugs, and other therapies, respectively; P < 0.001) compared with other cohorts. The CNIC-polypill intervention was less costly and more effective than any other therapeutic option, with €2317-€2407 cost savings per event prevented. Conclusion In IHD, the CNIC-polypill exemplifies a guideline-recommended secondary prevention treatment linked to better outcomes and cost saving compared with other therapeutic options.
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Affiliation(s)
- Regina Dalmau
- Department of Cardiology, University Hospital La Paz, Paseo de la Castellana 261, 28046 Madrid, Spain
- IdiPAZ (Instituto de Investigación Hospital Universitario la Paz), Pedro Rico 6, 28029 Madrid, Spain
| | - Alberto Cordero
- CIBERCV (Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares), Av. Monforte de Lemos, 3-5, 28029 Madrid, Spain
- Department of Cardiology, Hospital Universitario de San Juan, N-332 s/n, 03550 Sant Joan d’Alacant, Alicante, Spain
| | - Luís Masana
- Vascular Medicine and Metabolism Unit, Universitat Rovira i Virgili, Hospital Universitario Sant Joan, Vascular Medicine and Metabolism Unit, Avda Josep Laporte 2, 43204 Reus, Spain
- IISPV (Institut d’Investigació Sanitària Pere Virgili), Avda Josep Laporte 2, 43204 Reus, Spain
- CIBERDEM (Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas), Av. Monforte de Lemos, 3-5, 28029 Madrid, Spain
| | - Emilio Ruiz
- Corporate Medical Affairs, Ferrer International, Avenida Diagonal 549, 08029 Barcelona, Spain
| | - Antoni Sicras-Mainar
- Departament of Health Economics and Outcomes Research, Atrys Health, Provença 392, 08025 Barcelona, Spain
| | - José R González-Juanatey
- CIBERCV (Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares), Av. Monforte de Lemos, 3-5, 28029 Madrid, Spain
- Servicio de Cardiología, Hospital Clínico Universitario de Santiago de Compostela, Rúa da Choupana s/n, 15706 Santiago de Compostela, Spain
- Instituto de Investigación Sanitaria de Santiago de Compostela (IDIS), Rúa da Choupana s/n, 15706 Santiago de Compostela, Spain
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Gómez-Barrado JJ, Gómez-Turégano P, Beltrán Moreno M, Fernández-Chamorro AI, Roque Rodríguez B, Kounka Z. Lipoprotein (a) is a predictor of non-achievement of LDL-C goals in patients with chronic heart disease. Clin Investig Arterioscler 2024:S0214-9168(24)00006-8. [PMID: 38402025 DOI: 10.1016/j.arteri.2024.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 01/07/2024] [Accepted: 01/17/2024] [Indexed: 02/26/2024]
Abstract
INTRODUCTION AND OBJECTIVES Lipoprotein (a) [Lp(a)] concentration influences serum low-density lipoprotein cholesterol (LDL-C) levels. How it influences the achievement of LDL-C targets established in the guidelines is not well studied. Our aim was to know the prevalence of elevated Lp(a) levels in patients with coronary artery disease, and to assess its influence on the achievement of LDL-C targets. METHOD We conducted a cross-sectional study in a cardiology department in Spain. A total of 870 patients with stable coronary artery disease had their lipid profile determined, including Lp(a). Patients were stratified into 2 groups according to Lp(a)>50mg/dL and Lp(a)≤50mg/dL. The association of Lp(a)>50mg/dL with achievement of LDL-C targets was assessed by logistic regression analysis. RESULTS The prevalence of Lp(a)>50mg/dL was 30.8%. Patients with Lp(a)>50mg/dL had higher baseline (142.30±47.54 vs. 130.47±40.75mg/dL; p=0.0001) and current (72.91±26.44 vs. 64.72±25.30mg/dL; p=0.0001), despite the fact that they were treated with more high-potency statins (77.2 vs. 70.9%; p=0.058) and more combination lipid-lowering therapy (37.7 vs. 25.7%; p=0.001). The proportion of patients achieving target LDL-C was lower in those with Lp(a)>50mg/dL. Independent predictors of having elevated Lp(a) levels>50mg/dL were the use of high-potency statins (OR 1.5; 95% CI 1.08-2.14), combination lipid-lowering therapy with ezetimibe (OR 2.0; 95% CI 1.45-2.73) and failure to achieve a LDL-C ≤55mg/dL (OR 2.3; 95% CI 1.63-3.23). CONCLUSIONS Elevated Lp(a) levels influence LDL-C levels and hinder the achievement of targets in patients at very high cardiovascular risk. New drugs that act directly on Lp(a) are needed in these patients.
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Affiliation(s)
| | - Paula Gómez-Turégano
- Departamento de Cardiología, Hospital Universitario San Pedro de Alcántara, Cáceres, España
| | - María Beltrán Moreno
- Departamento de Cardiología, Hospital Universitario San Pedro de Alcántara, Cáceres, España
| | | | | | - Zineb Kounka
- Departamento de Cardiología, Hospital Universitario San Pedro de Alcántara, Cáceres, España
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17
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Flammer F, Paraschiv-Ionescu A, Marques-Vidal P. It needs more than a myocardial infarction to start exercising: the CoLaus|PsyCoLaus prospective study. BMC Cardiovasc Disord 2024; 24:102. [PMID: 38347464 PMCID: PMC10863136 DOI: 10.1186/s12872-024-03755-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 01/29/2024] [Indexed: 02/15/2024] Open
Abstract
BACKGROUND Increased physical activity (PA) is recommended after an acute coronary event to prevent recurrences. Whether patients with acute coronary event actually increase their PA has not been assessed using objective methods such as accelerometer. We aimed to assess the subjectively and objectively measured physical activity (PA) levels of patients before and after an acute coronary event. METHODS Data from the three follow-up surveys of a prospective study conducted in Lausanne, Switzerland. Self-reported PA was assessed by questionnaire in the first (2009-2012) and second (2014-2017) follow-ups. Objective PA was assessed by a wrist-worn accelerometer in the second and third (2018-2021) follow-ups. Participants who developed an acute coronary event between each survey period were considered as eligible. PA levels were compared before and after the event, and changes in PA levels were also compared between participants who developed an acute event with three gender and age-matched healthy controls. RESULTS For self-reported PA, data from 43 patients (12 women, 64 ± 9 years) were used. No differences were found for all PA levels expressed in minutes/day before and after the event: moderate PA, median and [interquartile range] 167 [104-250] vs. 153 [109-240]; light PA: 151 [77-259] vs. 166 [126-222], and sedentary behaviour: 513 [450-635] vs. 535 [465-642] minutes/day. Comparison with gender- and age-matched healthy controls showed no differences regarding trends in reported PA. For accelerometer-assessed PA, data from 32 patients (16 women, 66 ± 9 years) were used. No differences were found for all PA levels expressed in minutes/day before and after the event: moderate PA: 159 [113-189] vs. 141 [111-189]; light PA: 95.8 [79-113] vs. 95.9 [79-117], and sedentary behaviour: 610 [545-659] vs. 602 [540-624]. Regarding the comparison with gender- and age-matched healthy controls, controls had an increase in accelerometer-assessed sedentary behaviour as % of day: multivariable adjusted average standard error 2.7 ± 0.6, while no increase was found for cases: 0.1 ± 1.1; no differences were found for the other PA levels. CONCLUSION Patients do not seem to change their PA levels after a first coronary event. Our results should be confirmed in larger samples.
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Affiliation(s)
- François Flammer
- Department of Medicine, Internal Medicine, Lausanne University Hospital and University of Lausanne, 46 rue du Bugnon, Lausanne, 1011, Switzerland
| | - Anisoara Paraschiv-Ionescu
- Laboratory of Movement Analysis and Measurement (LMAM), Ecole Polytechnique Federale de Lausanne (EPFL), Lausanne, Switzerland
| | - Pedro Marques-Vidal
- Department of Medicine, Internal Medicine, Lausanne University Hospital and University of Lausanne, 46 rue du Bugnon, Lausanne, 1011, Switzerland.
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18
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Byrne RA, Rossello X, Coughlan JJ, Barbato E, Berry C, Chieffo A, Claeys MJ, Dan GA, Dweck MR, Galbraith M, Gilard M, Hinterbuchner L, Jankowska EA, Jüni P, Kimura T, Kunadian V, Leosdottir M, Lorusso R, Pedretti RFE, Rigopoulos AG, Rubini Gimenez M, Thiele H, Vranckx P, Wassmann S, Wenger NK, Ibanez B. 2023 ESC Guidelines for the management of acute coronary syndromes. Eur Heart J Acute Cardiovasc Care 2024; 13:55-161. [PMID: 37740496 DOI: 10.1093/ehjacc/zuad107] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/24/2023]
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19
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Takkavatakarn K, Dai Y, Hsun Wen H, Kauffman J, Charney A, Coca SG, Nadkarni GN, Chan L. Comparison of predicting cardiovascular disease hospitalization using individual, ZIP code-derived, and machine learning model-predicted educational attainment in New York City. PLoS One 2024; 19:e0297919. [PMID: 38329973 PMCID: PMC10852236 DOI: 10.1371/journal.pone.0297919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 01/15/2024] [Indexed: 02/10/2024] Open
Abstract
BACKGROUND Area-level social determinants of health (SDOH) based on patients' ZIP codes or census tracts have been commonly used in research instead of individual SDOHs. To our knowledge, whether machine learning (ML) could be used to derive individual SDOH measures, specifically individual educational attainment, is unknown. METHODS This is a retrospective study using data from the Mount Sinai BioMe Biobank. We included participants that completed a validated questionnaire on educational attainment and had home addresses in New York City. ZIP code-level education was derived from the American Community Survey matched for the participant's gender and race/ethnicity. We tested several algorithms to predict individual educational attainment from routinely collected clinical and demographic data. To evaluate how using different measures of educational attainment will impact model performance, we developed three distinct models for predicting cardiovascular (CVD) hospitalization. Educational attainment was imputed into models as either survey-derived, ZIP code-derived, or ML-predicted educational attainment. RESULTS A total of 20,805 participants met inclusion criteria. Concordance between survey and ZIP code-derived education was 47%, while the concordance between survey and ML model-predicted education was 67%. A total of 13,715 patients from the cohort were included into our CVD hospitalization prediction models, of which 1,538 (11.2%) had a history of CVD hospitalization. The AUROC of the model predicting CVD hospitalization using survey-derived education was significantly higher than the model using ZIP code-level education (0.77 versus 0.72; p < 0.001) and the model using ML model-predicted education (0.77 versus 0.75; p < 0.001). The AUROC for the model using ML model-predicted education was also significantly higher than that using ZIP code-level education (p = 0.003). CONCLUSION The concordance of survey and ZIP code-level educational attainment in NYC was low. As expected, the model utilizing survey-derived education achieved the highest performance. The model incorporating our ML model-predicted education outperformed the model relying on ZIP code-derived education. Implementing ML techniques can improve the accuracy of SDOH data and consequently increase the predictive performance of outcome models.
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Affiliation(s)
- Kullaya Takkavatakarn
- Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
- Division of Nephrology, Department of Medicine, King Chulalongkorn Memorial Hospital, Chulalongkorn University, Bangkok, Thailand
| | - Yang Dai
- The Charles Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
| | - Huei Hsun Wen
- Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
| | - Justin Kauffman
- The Charles Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
| | - Alexander Charney
- The Charles Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
| | - Steven G. Coca
- Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
| | - Girish N. Nadkarni
- Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
- The Charles Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
- Division of Data Driven and Digital Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
| | - Lili Chan
- Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
- The Charles Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
- Division of Data Driven and Digital Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
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20
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Wittboldt S, Leosdottir M, Ravn Fischer A, Ekman B, Bäck M. Exercise-based cardiac rehabilitation after acute myocardial infarction in Sweden - standards, costs, and adherence to European guidelines (The Perfect-CR study). Physiother Theory Pract 2024; 40:366-376. [PMID: 36047009 DOI: 10.1080/09593985.2022.2114052] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 08/11/2022] [Indexed: 10/14/2022]
Abstract
AIMS Information on standards including structure- and process-based metrics and how exercise-based cardiac rehabilitation (EBCR) is delivered in relation to guidelines is lacking. The aims of the study were to evaluate standards and adherence to guidelines at Swedish CR centers and to conduct a cost analysis of the physiotherapy-related activities of EBCR. METHODS AND RESULTS EBCR standards at all 78 CR centers in Sweden in 2016 were surveyed. The questions were based on guideline-recommended core components of EBCR for patients after a myocardial infarction (MI). The cost analysis included the identification, quantification, and valuation of EBCR-related cost items. Patients were offered a pre-discharge consultation with a physiotherapist at n = 61, 78% of the centers. A pre-exercise screening visit was routinely offered at n = 64, 82% of the centers, at which a test of aerobic capacity was offered in n = 58, 91% of cases, most often as a cycle ergometer exercise test n = 55, 86%. A post-exercise assessment was offered at n = 44, 56% of the centers, with a functional test performed at n = 30, 68%. Almost all the centers n = 76, 97% offered supervised EBCR programs. The total cost of delivering physiotherapy-related activities of EBCR according to guidelines was approximately 437 euro (4,371 SEK) per patient. Delivering EBCR to one MI patient required 11.25 hours of physiotherapy time. CONCLUSION While the overall quality of EBCR programs in Sweden is high, there are several areas of potential improvement to reach the recommended European standards across all centers. To improve the quality of EBCR, further compliance with guidelines is warranted.
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Affiliation(s)
- Susanna Wittboldt
- Department of Occupational Therapy and Physiotherapy, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | | | - Annica Ravn Fischer
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Björn Ekman
- Department of Clinical Sciences Malmö, Lund University, Lund, Sweden
| | - Maria Bäck
- Department of Occupational Therapy and Physiotherapy, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Medical and Health Sciences, Division of Physiotherapy, Linköping University, Linköping, Sweden
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21
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van de Borne P, Peeters A, Janssens L, Leone A, Lemmens R, Verhaegen A, De Meulemeester M, Balthazar Y, Heijmans S, Calozet Y, Paquot N, Carlier S, Hemelsoet D, Bray S, Ray KK. Lipid-lowering therapy and risk-based LDL-C goal attainment in Belgium: DA VINCI observational study. Acta Cardiol 2024; 79:20-29. [PMID: 35442151 DOI: 10.1080/00015385.2022.2030568] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 10/01/2021] [Accepted: 01/11/2022] [Indexed: 01/21/2023]
Abstract
BACKGROUND Cardiovascular disease (CVD) is one of the leading causes of death in Belgium. Current strategies for the prevention and management of CVD focus on reducing low-density lipoprotein cholesterol (LDL-C) levels. This analysis assessed whether LDL-C goals, recommended by the European Society of Cardiology (ESC)/European Atherosclerosis Society (EAS) guidelines, were being achieved in a Belgian study population. METHODS The cross-sectional, observational, DA VINCI study enrolled patients prescribed lipid-lowering therapy (LLT) between 21 June 2017 and 20 November 2018. Data for patients from Belgium were extracted for this country-specific analysis. Primary endpoint was the proportion of patients who achieved 2016 ESC/EAS risk-based LDL-C goals; attainment of 2019 risk-based LDL-C goals was evaluated post hoc. RESULTS Of 497 enrolled patients, 41% were female and mean age was 68 years. Among subjects with an LDL-C measurement on stabilised LLT, moderate-intensity statin monotherapy was the most prescribed LLT regimen (59%). Overall, 63% of patients achieved their risk-based LDL-C goals according to the 2016 ESC/EAS guidelines. Among patients with established ASCVD, risk-based LDL-C goal attainment was higher in patients with peripheral arterial disease (53%) than patients with coronary (37%) and cerebrovascular disease (42%). According to the updated 2019 ESC/EAS guidelines, less than half (41%) of patients achieved their risk-based LDL-C goal. The proportion of primary and secondary prevention patients who achieved 2019 risk-based LDL-C goals was 59% and 18%, respectively. CONCLUSION These findings reveal a large gap between the LDL-C goals advocated by the ESC/EAS and the levels achieved in routine clinical practice in Belgium.
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Affiliation(s)
- Philippe van de Borne
- Department of Cardiology, Erasme Hospital, University Libre of Brussels, Brussels, Belgium
| | - André Peeters
- Department of Neurology, Saint Luc University Clinic, Brussels, Belgium
| | - Luc Janssens
- Department of Cardiology, Imelda Hospital, Bonheiden, Belgium
| | - Attilio Leone
- Department of Cardiology, Tivoli University Hospital Centre, La Louvière, Belgium
| | - Robin Lemmens
- Department of Neurology, University Hospitals Leuven and KU Leuven, Leuven, Belgium
| | - Ann Verhaegen
- Department of Endocrinology, Diabetes and Metabolism, Antwerp University Hospital, Edegem, Belgium
| | | | | | | | | | - Nicolas Paquot
- Department of Diabetology, Nutrition and Metabolic Diseases, Sart Tilman University Hospital Center, Liège, Belgium
| | - Stéphane Carlier
- Department of Cardiology, Ambroise Paré Hospital and University of Mons (UMONS), Mons, Belgium
| | | | - Sarah Bray
- Global Biostatistical Science, Amgen Ltd, Cambridge, UK
| | - Kausik K Ray
- Imperial Centre for Cardiovascular Disease Prevention and Imperial Clinical Trials Unit, Imperial College London, London, UK
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22
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Jacobsson RJ, Oikarinen A, Krogell J, Kankkunen P. Group-based cardiac telerehabilitation interventions and health outcomes in coronary patients: A scoping review. Clin Rehabil 2024; 38:184-201. [PMID: 37731365 PMCID: PMC10725089 DOI: 10.1177/02692155231202855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 09/06/2023] [Indexed: 09/22/2023]
Abstract
OBJECTIVE To explore the extent and type of evidence in relation to group-based cardiac telerehabilitation interventions and health outcomes in coronary artery disease patients. DATA SOURCES A literature search was conducted in August 2022 and July 2023 in databases including PubMed, CINAHL, Scopus and PsycINFO. The search process followed the scoping review methodology guided by the Joanna Briggs Institute for scoping reviews. METHODS The inclusion criteria were a peer-reviewed journal article published in English between 1 January 2017 and 15 August 2022 and updated to cover until 15 July 2023 concerning group-based cardiac telerehabilitation in adult coronary artery disease patients. All group-based cardiac telerehabilitation interventions and health outcome types were charted and summarized. RESULTS The researcher screened a total of 2089 articles, of which 22 were retained with a total of 1596 participants. Group-based cardiac telerehabilitation interventions were particularly useful for patients with multi-faceted technological applications and social support. The patients received guidance regarding cardiovascular disease risk factors. Physical fitness, psychological complaints and quality of life were often measured outcomes in the included studies. CONCLUSIONS This scoping review indicates the success of various rehabilitation interventions utilizing different technologies for coronary patients. Coronary patients were guided in making lifestyle changes, and positive findings were observed in the health outcomes measured after the telerehabilitation intervention. The findings of this review can provide valuable guidance for developing and evaluating sustainable group-based cardiac telerehabilitation programs that aim to benefit coronary patients.
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Affiliation(s)
- Renuka J Jacobsson
- Department of Nursing Science, Faculty of Health Sciences, University of Eastern Finland, Kuopio,
Finland
| | - Anne Oikarinen
- Research Unit of Health Sciences and Technology, Faculty of Medicine, University of Oulu, Oulu, Finland
| | - Jenni Krogell
- Department of Nursing Science, Faculty of Health Sciences, University of Eastern Finland, Kuopio,
Finland
| | - Päivi Kankkunen
- Department of Nursing Science, Faculty of Health Sciences, University of Eastern Finland, Kuopio,
Finland
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23
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Pogosova NV, Boytsov SA. Preventive Cardiology 2024: State of Problem Perspectives of Development. Kardiologiia 2024; 64:4-13. [PMID: 38323439 DOI: 10.18087/cardio.2024.1.n2636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 01/29/2024] [Indexed: 02/08/2024]
Abstract
This article presents the current relevance of preventive cardiology, substantiates the increasing importance of the prevention of cardiovascular diseases (CVD) to reduce mortality and the burden of CVD, including in the era of widespread use of modern high-tech methods and effective drug therapy for treating CVD in clinical practice. The article also addresses effectiveness of secondary prevention of CVD and approaches to its improvement. Particular attention is paid to the high importance of introducing into practice comprehensive programs for secondary prevention of CVD and cardiac rehabilitation. The principles of organizing such programs and their most important components are presented in detail.
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Affiliation(s)
- N V Pogosova
- Chazov National Medical Research Center of Cardiology, Moscow; "Russian Peoples' Friendship University named after. P. Lumumba", Moscow
| | - S A Boytsov
- Chazov National Medical Research Center of Cardiology, Moscow
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24
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Bonekamp NE, Visseren FLJ, Cramer MJ, Dorresteijn JAN, van der Meer MG, Ruigrok YM, van Sloten TT, Teraa M, Geleijnse JM, Koopal C. Long-term lifestyle change and risk of mortality and Type 2 diabetes in patients with cardiovascular disease. Eur J Prev Cardiol 2024; 31:205-213. [PMID: 37774501 DOI: 10.1093/eurjpc/zwad316] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 08/18/2023] [Accepted: 09/22/2023] [Indexed: 10/01/2023]
Abstract
AIMS To quantify the relationship between self-reported, long-term lifestyle changes (smoking, waist circumference, physical activity, and alcohol consumption) and clinical outcomes in patients with established cardiovascular disease (CVD). METHODS AND RESULTS Data were used from 2011 participants (78% male, age 57 ± 9 years) from the Utrecht Cardiovascular Cohort-Second Manifestations of ARTerial disease cohort who returned for a re-assessment visit (SMART2) after ∼10 years. Self-reported lifestyle change was classified as persistently healthy, improved, worsened, or persistently unhealthy. Cox proportional hazard models were used to quantify the relationship between lifestyle changes and the risk of (cardiovascular) mortality and incident Type 2 diabetes (T2D). Fifty-seven per cent of participants was persistently healthy, 17% improved their lifestyle, 8% worsened, and 17% was persistently unhealthy. During a median follow-up time of 6.1 (inter-quartile range 3.6-9.6) years after the SMART2 visit, 285 deaths occurred, and 99 new T2D diagnoses were made. Compared with a persistently unhealthy lifestyle, individuals who maintained a healthy lifestyle had a lower risk of all-cause mortality [hazard ratio (HR) 0.48, 95% confidence interval (CI) 0.36-0.63], cardiovascular mortality (HR 0.57, 95% CI 0.38-0.87), and incident T2D (HR 0.46, 95% CI 0.28-0.73). Similarly, those who improved their lifestyle had a lower risk of all-cause mortality (HR 0.52, 95% CI 0.37-0.74), cardiovascular mortality (HR 0.46, 95% CI 0.26-0.81), and incident T2D (HR 0.50, 95% CI 0.27-0.92). CONCLUSION These findings suggest that maintaining or adopting a healthy lifestyle can significantly lower mortality and incident T2D risk in CVD patients. This study emphasizes the importance of ongoing lifestyle optimization in CVD patients, highlighting the potential for positive change regardless of previous lifestyle habits.
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Affiliation(s)
- Nadia E Bonekamp
- Department of Vascular Medicine, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, Postbus 85500, 3508 GA, Utrecht, The Netherlands
| | - Frank L J Visseren
- Department of Vascular Medicine, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, Postbus 85500, 3508 GA, Utrecht, The Netherlands
| | - Maarten J Cramer
- Department of Cardiology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Jannick A N Dorresteijn
- Department of Vascular Medicine, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, Postbus 85500, 3508 GA, Utrecht, The Netherlands
| | - Manon G van der Meer
- Department of Cardiology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Ynte M Ruigrok
- UMC Utrecht Brain Center, Department of Neurology and Neurosurgery, Utrecht University, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Thomas T van Sloten
- Department of Vascular Medicine, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, Postbus 85500, 3508 GA, Utrecht, The Netherlands
| | - Martin Teraa
- Department of Vascular Surgery, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Johanna M Geleijnse
- Division of Human Nutrition and Health, Wageningen University, Wageningen, The Netherlands
| | - Charlotte Koopal
- Department of Vascular Medicine, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, Postbus 85500, 3508 GA, Utrecht, The Netherlands
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25
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Laranjo L, Lanas F, Sun MC, Chen DA, Hynes L, Imran TF, Kazi DS, Kengne AP, Komiyama M, Kuwabara M, Lim J, Perel P, Piñeiro DJ, Ponte-Negretti CI, Séverin T, Thompson DR, Tokgözoğlu L, Yan LL, Chow CK. World Heart Federation Roadmap for Secondary Prevention of Cardiovascular Disease: 2023 Update. Glob Heart 2024; 19:8. [PMID: 38273995 PMCID: PMC10809857 DOI: 10.5334/gh.1278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 11/16/2023] [Indexed: 01/27/2024] Open
Abstract
Background Secondary prevention lifestyle and pharmacological treatment of atherosclerotic cardiovascular disease (ASCVD) reduce a high proportion of recurrent events and mortality. However, significant gaps exist between guideline recommendations and usual clinical practice. Objectives Describe the state of the art, the roadblocks, and successful strategies to overcome them in ASCVD secondary prevention management. Methods A writing group reviewed guidelines and research papers and received inputs from an international committee composed of cardiovascular prevention and health systems experts about the article's structure, content, and draft. Finally, an external expert group reviewed the paper. Results Smoking cessation, physical activity, diet and weight management, antiplatelets, statins, beta-blockers, renin-angiotensin-aldosterone system inhibitors, and cardiac rehabilitation reduce events and mortality. Potential roadblocks may occur at the individual, healthcare provider, and health system levels and include lack of access to healthcare and medicines, clinical inertia, lack of primary care infrastructure or built environments that support preventive cardiovascular health behaviours. Possible solutions include improving health literacy, self-management strategies, national policies to improve lifestyle and access to secondary prevention medication (including fix-dose combination therapy), implementing rehabilitation programs, and incorporating digital health interventions. Digital tools are being examined in a range of settings from enhancing self-management, risk factor control, and cardiac rehab. Conclusions Effective strategies for secondary prevention management exist, but there are barriers to their implementation. WHF roadmaps can facilitate the development of a strategic plan to identify and implement local and national level approaches for improving secondary prevention.
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Affiliation(s)
- Liliana Laranjo
- Westmead Applied Research Centre, University of Sydney, Sydney, Australia
| | | | - Marie Chan Sun
- Department of Medicine, University of Mauritius, Réduit, Mauritius
| | | | - Lisa Hynes
- Croí, the West of Ireland Cardiac & Stroke Foundation, Galway, Ireland
| | - Tasnim F. Imran
- Department of Medicine, Division of Cardiology, Warren Alpert Medical School of Brown University, Providence VA Medical Center, Lifespan Cardiovascular Institute, Providence, US
| | - Dhruv S. Kazi
- Department of Medicine (Cardiology), Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, US
| | - Andre Pascal Kengne
- Non-Communicable Diseases Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Maki Komiyama
- Clinical Research Institute, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | | | - Jeremy Lim
- Global Health Dpt, National University of Singapore Saw Swee Hock School of Public Health, Singapore
| | - Pablo Perel
- Non Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine and World Heart Federation, London, UK
| | | | | | | | - David R. Thompson
- School of Nursing and Midwifery, Queen’s University Belfast, United Kingdom
- European Association of Preventive Cardiology, Sophia Antipolis, UK
| | - Lale Tokgözoğlu
- Department of Cardiology, Hacettepe University, Ankara, Turkey
| | - Lijing L. Yan
- Global Health Research Center, Duke Kunshan University, China
| | - Clara K. Chow
- Faculty of Medicina and Health, Westmead Applied Research Centre, University of Sydney, Australia
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Hjertvikrem N, Brørs G, Instenes I, Helmark C, Pettersen TR, Rotevatn S, Zwisler ADO, Norekvål TM. Use of health services and perceived need for information and follow-up after percutaneous coronary intervention. BMC Res Notes 2024; 17:20. [PMID: 38183067 PMCID: PMC10768322 DOI: 10.1186/s13104-023-06662-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 12/11/2023] [Indexed: 01/07/2024] Open
Abstract
OBJECTIVE Few patients achieve full control of their coronary artery disease (CAD) risk factors. Follow-up, such as cardiac rehabilitation, is important to increase adherence to lifestyle changes and treatment, to improve the patient's risk profile, and to treat established complications of CAD clinical events. However, the type of follow-up patients receive varies. Therefore, the aim of this research note was to describe and compare patients' self-reported use of health services, the type of follow-up patients reported to prefer, and the type of information patients reported to be important, in two countries with different follow-up practices after PCI. RESULTS We included 3417 patients in Norway and Denmark, countries with different follow-up strategies after PCI. The results showed large differences between the countries regarding health services used. In Denmark the most frequently used health services were consultations at outpatient clinics followed by visits to the general practitioner and visits to the fitness centre, whereas in Norway visits to the general practitioner were most common, followed by rehospitalisation and no follow-up used. However, patients found the same type of follow-up and information important in both countries. Patients' perceived need for follow-up and information decreased over time, suggesting a need for early follow-up when the patients are motivated. TRIAL REGISTRATION NCT03810612 (18/01/2019).
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Affiliation(s)
- Nina Hjertvikrem
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway.
| | - Gunhild Brørs
- Clinic of Cardiology, St. Olavs University Hospital, Trondheim, Norway
| | - Irene Instenes
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
- Faculty of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | - Charlotte Helmark
- Department of Cardiology, Zealand University Hospital, Roskilde, Denmark
| | - Trond Røed Pettersen
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
- Faculty of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | - Svein Rotevatn
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - Ann Dorthe O Zwisler
- Department of Cardiology, Odense University Hospital, Odense, Denmark
- REHPA, Knowledge Centre for Rehabilitation and Palliative Care, Nyborg, Denmark
| | - Tone Merete Norekvål
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
- Faculty of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway
- Department of Clinical Science, University of Bergen, Bergen, Norway
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Rakers M, van Hattem N, Plag S, Chavannes N, van Os HJA, Vos RC. Population health interventions for cardiometabolic diseases in primary care: a scoping review and RE-AIM evaluation of current practices. Front Med (Lausanne) 2024; 10:1275267. [PMID: 38239619 PMCID: PMC10794664 DOI: 10.3389/fmed.2023.1275267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 12/13/2023] [Indexed: 01/22/2024] Open
Abstract
Introduction Cardiometabolic diseases (CMD) are the leading cause of death in high-income countries and are largely attributable to modifiable risk factors. Population health management (PHM) can effectively identify patient subgroups at high risk of CMD and address missed opportunities for preventive disease management. Guided by the Reach, Efficacy, Adoption, Implementation and Maintenance (RE-AIM) framework, this scoping review of PHM interventions targeting patients in primary care at increased risk of CMD aims to describe the reported aspects for successful implementation. Methods A comprehensive search was conducted across 14 databases to identify papers published between 2000 and 2023, using Arksey and O'Malley's framework for conducting scoping reviews. The RE-AIM framework was used to assess the implementation, documentation, and the population health impact score of the PHM interventions. Results A total of 26 out of 1,100 studies were included, representing 21 unique PHM interventions. This review found insufficient reporting of most RE-AIM components. The RE-AIM evaluation showed that the included interventions could potentially reach a large audience and achieve their intended goals, but information on adoption and maintenance was often lacking. A population health impact score was calculated for six interventions ranging from 28 to 62%. Discussion This review showed the promise of PHM interventions that could reaching a substantial number of participants and reducing CMD risk factors. However, to better assess the generalizability and scalability of these interventions there is a need for an improved assessment of adoption, implementation processes, and sustainability.
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Affiliation(s)
- Margot Rakers
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, Netherlands
| | - Nicoline van Hattem
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, Netherlands
| | - Sabine Plag
- Health Campus the Hague, Leiden University Medical Center, The Hague, Netherlands
| | - Niels Chavannes
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, Netherlands
| | - Hendrikus J. A. van Os
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, Netherlands
| | - Rimke C. Vos
- Health Campus the Hague, Leiden University Medical Center, The Hague, Netherlands
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Gavina C, Seabra‐Carvalho D, Aguiar C, Anastassopoulou A, Teixeira C, Ruivo JA, Almeida É, Luz‐Duarte L, Corte‐Real A, Canelas‐Pais M, Taveira‐Gomes T. Characterization and LDL-C management in a cohort of high and very high cardiovascular risk patients: The PORTRAIT-DYS study. Clin Cardiol 2024; 47:e24183. [PMID: 37933175 PMCID: PMC10766132 DOI: 10.1002/clc.24183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 10/23/2023] [Accepted: 10/24/2023] [Indexed: 11/08/2023] Open
Abstract
AIM This study aims to characterize sociodemographic and clinical characteristics, use of lipid-lowering therapies (LLTs), and low-density lipoprotein cholesterol (LDL-C) control in a population with increased cardiovascular (CV) risk. METHODS A cross-sectional observational study that uses electronic health records of patients from one hospital and across 14 primary care health centers in the North of Portugal, spanning from 2000 to 2020 (index date). Patients presented at least (i) 1 year of clinical data before inclusion, (ii) one primary care appointment 3 years before the index date, and (iii) sufficient data for CV risk classification. Patients were divided into three cohorts: high CV risk; atherosclerotic cardiovascular disease (ASCVD) risk equivalents without established ASCVD; evidence of ASCVD. CV risk and LDL-C control were defined by the 2019 and 2016 European Society of Cardiology (ESC)/European Atherosclerosis Society (EAS) dyslipidemia guidelines. RESULTS A total of 51 609 patients were included, with 23 457 patients classified as high CV risk, 19 864 with ASCVD equivalents, and 8288 with evidence of ASCVD. LDL-C control with 2016 ESC/EAS guidelines was 32%, 10%, and 18% for each group, respectively. Considering the ESC/EAS 2019 guidelines control level was even lower: 7%, 3%, and 7% for the same cohorts, respectively. Patients without any LLT prescribed ranged from 37% in the high CV risk group to 15% in patients with evidence of ASCVD. CONCLUSION We found that LDL-C control was very low in patients at higher risk of CV events. An alarming gap between guidelines on dyslipidemia management and clinical implementation persists, even in those at very high risk or with established ASCVD.
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Affiliation(s)
- Cristina Gavina
- Hospital Pedro Hispano ‐ Unidade Local de Saúde de MatosinhosPortugal
- Department of Medicine, Faculty of MedicinePorto UniversityPortoPortugal
- UnIC, Faculty of MedicinePorto UniversityPortoPortugal
| | | | - Carlos Aguiar
- Advanced Heart Failure Unit, Department of CardiologyHospital Santa Cruz, CHLOLisbonPortugal
| | | | - Carla Teixeira
- Medical AffairsDaiichi Sankyo PortugalPorto SalvoPortugal
| | - Jorge A. Ruivo
- Medical AffairsDaiichi Sankyo PortugalPorto SalvoPortugal
- Department of Medicine, Lisbon Medical SchoolLisbon UniversityPortugal
- Centro Cardiovascular Universidade LisboaLisbon UniversityPortugal
| | - Élia Almeida
- Value and AccessDaiichi Sankyo PortugalPorto SalvoPortugal
| | - Leonor Luz‐Duarte
- UCSP CinfãesACeS BaixoPortugal
- MTG Research and Development LabPortoPortugal
| | - Ana Corte‐Real
- MTG Research and Development LabPortoPortugal
- UCSP BarroselasUnidade Local de Saúde do Alto MinhoPortugal
| | - Mariana Canelas‐Pais
- MTG Research and Development LabPortoPortugal
- Department of Community Medicine, Health Information and Decision, Faculty of MedicineUniversity of PortoPortoPortugal
| | - Tiago Taveira‐Gomes
- MTG Research and Development LabPortoPortugal
- Department of Community Medicine, Health Information and Decision, Faculty of MedicineUniversity of PortoPortoPortugal
- Faculty of Health SciencesFernando Pessoa UniversityPortugal
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Vigneshwaran E, AlShahrani SM, Alanzi AR, Mohammad AAS, Sadiq MMJ, Khan NA, Alavudeen SS. Comparing knowledge, attitudes, and practices in cardiovascular disease prevention and health promotion between community and hospital pharmacists in Saudi Arabia: A cross-sectional study. Saudi Pharm J 2024; 32:101890. [PMID: 38192383 PMCID: PMC10772382 DOI: 10.1016/j.jsps.2023.101890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 11/30/2023] [Indexed: 01/10/2024] Open
Abstract
Purpose Saudi Arabia is one of the leading nations in the world in terms of the high frequency of chronic diseases and their associated risk factors. Knowledge and awareness are crucial for pharmacists to play an active role in the prevention of cardiovascular diseases (CVD). The current study assessed the pharmacists' knowledge, attitude, and practice to determine the potential differences with respect to their respective practice settings toward CVD prevention and related health promotions. Methods It is a cross-sectional study targeted the registered pharmacists in the Kingdom of Saudi Arabia. An online questionnaire was prepared, and the link was circulated through various social media platforms. Descriptive statistics, multivariate linear regression analysis and chi square test were used to analyze the data accordingly. Results A total of 324 pharmacists were included in the study. Among these, 157 (48.4 %) were community pharmacists, and the remaining were hospital pharmacists (51.6 %). No significant differences in knowledge scores were observed between community and hospital pharmacists. The mean attitude score among community and hospital pharmacists was found to be 26.40 ± 5.125 and 25.09 ± 5.393 respectively, which was statistically significant (p = 0.026). Similarly, the total practice scores across the settings were statistically significant (p = 0.02). Gender plays a significant role in terms of knowledge scores among both community and hospital pharmacists (p = 0.016 & 0.029). Gender, professional practice experience, and number of prescriptions handled and prescriptions with CVD medications showed significant differences in the distribution of positive attitudes and good practice frequency between community and hospital pharmacists. Conclusion It is evident that there is a deficiency in knowledge among hospital pharmacists compared to community pharmacists. Which indicates that there is a need for a rigorous continuous pharmacy education covering the fundamental aspects of CVD primary prevention and health promotion among pharmacists, given more focus on hospital pharmacists.
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Affiliation(s)
- Easwaran Vigneshwaran
- Department of Clinical Pharmacy, College of Pharmacy, King Khalid University, Abha, Saudi Arabia
| | - Sultan M. AlShahrani
- Department of Clinical Pharmacy, College of Pharmacy, King Khalid University, Abha, Saudi Arabia
| | - Abdullah R. Alanzi
- Department of Pharmacognosy, College of Pharmacy, King Saud University, Riyadh 11451, Saudi Arabia
| | | | | | - Noohu Abdulla Khan
- Department of Clinical Pharmacy, College of Pharmacy, King Khalid University, Abha, Saudi Arabia
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IJzerman RVH, van der Vaart R, Breeman LD, van den Broek I, Keesman M, Kraaijenhagen RA, Reijnders T, Weerts M, Evers AWM, Scholte Op Reimer WJM, Janssen VR. Brief lifestyle advice in cardiac care: an experimental study on message source and framing. Neth Heart J 2024; 32:38-44. [PMID: 37945935 PMCID: PMC10781907 DOI: 10.1007/s12471-023-01827-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/29/2023] [Indexed: 11/12/2023] Open
Abstract
OBJECTIVE Communicating risk information and offering lifestyle advice are important goals in cardiac rehabilitation. However, the most effective way and the most effective source to communicate this information are not yet known. Therefore, we examined the effect of source (cardiologist, physiotherapist) and framing (gain, loss) of brief lifestyle advice on patients' intention-to-change-lifestyle. METHODS In an online experimental study, 636 cardiac patients (40% female, 67 (10) yrs.) were randomly assigned to one of four textual vignettes. Effect of source and framing on intention-to-change-lifestyle (assessed using a 5-point Likert scale) was analysed using analysis of covariance (ANCOVA). RESULTS Patients expressed positive intention-to-change-lifestyle after receiving advice from the cardiologist (M = 4.1) and physiotherapist (M = 3.9). However, patients showed significantly higher intention-to-change-lifestyle after receiving advice from the cardiologist (0.58 [0.54-0.61]) when compared with the physiotherapist (0.52 [0.48-0.56]), (F[1,609] = 7.06, P = 0.01). Gain-framed and loss-framed advice appeared equally effective. However, communicating risks (loss) was remembered by only 9% of patients, whereas 89% remembered benefits (gain). CONCLUSIONS Our study shows the value of cardiologists and physiotherapists communicating brief lifestyle advice, as cardiac patients expressed positive intention for lifestyle change after receiving advice, irrespective of framing. Lifestyle advice should include benefits due to better recall.
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Affiliation(s)
- Renée V H IJzerman
- Health, Medical and Neuropsychology Unit, Leiden University, Leiden, The Netherlands.
- Department of Cardiology, Amsterdam University Medical Centres, University of Amsterdam, Amsterdam, The Netherlands.
| | - Rosalie van der Vaart
- Health, Medical and Neuropsychology Unit, Leiden University, Leiden, The Netherlands
| | - Linda D Breeman
- Health, Medical and Neuropsychology Unit, Leiden University, Leiden, The Netherlands
| | | | - Mike Keesman
- Health, Medical and Neuropsychology Unit, Leiden University, Leiden, The Netherlands
| | | | - Thomas Reijnders
- Health, Medical and Neuropsychology Unit, Leiden University, Leiden, The Netherlands
| | | | - Andrea W M Evers
- Health, Medical and Neuropsychology Unit, Leiden University, Leiden, The Netherlands
- Medical Delta, Healthy Society, Leiden University, Technical University Delft, Erasmus University, Leiden, Delft, Rotterdam, The Netherlands
| | - Wilma J M Scholte Op Reimer
- Department of Cardiology, Amsterdam University Medical Centres, University of Amsterdam, Amsterdam, The Netherlands
- Research Group Chronic Diseases, HU University of Applied Sciences, Utrecht, The Netherlands
| | - Veronica R Janssen
- Health, Medical and Neuropsychology Unit, Leiden University, Leiden, The Netherlands
- Department of Cardiology, Leiden University Medical Centre, Leiden, The Netherlands
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31
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Heutinck JM, de Koning IA, Vromen T, Thijssen DHJ, Kemps HMC. Exercise-based cardiac rehabilitation in stable angina pectoris: a narrative review on current evidence and underlying physiological mechanisms. Neth Heart J 2024; 32:23-30. [PMID: 37982981 PMCID: PMC10781904 DOI: 10.1007/s12471-023-01830-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/10/2023] [Indexed: 11/21/2023] Open
Abstract
Stable angina pectoris (SAP) is a prevalent condition characterised by a high disease burden. Based on recent evidence, the need for revascularisation in addition to optimal medical treatment to reduce mortality and re-events is heavily debated. These observations may be explained by the fact that revascularisation is targeted at the local flow-limiting coronary artery lesion, while the aetiology of SAP relates to the systemic, inflammatory process of atherosclerosis, causing generalised vascular dysfunction throughout the entire vascular system. Moreover, cardiovascular events are not solely caused by obstructive plaques but are also associated with plaque burden and high-risk plaque features. Therefore, to reduce the risk of cardiovascular events and angina, and thereby improve quality of life, alternative therapeutic approaches to revascularisation should be considered, preferably targeting the cardiovascular system as a whole with a physiological approach. Exercise-based cardiac rehabilitation fits this description and is a promising strategy as a first-line treatment in addition to optimal medical treatment. In this review, we discuss the role of exercise-based cardiac rehabilitation in SAP in relation to the underlying physiological mechanisms, we summarise the existing evidence and highlight future directions.
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Affiliation(s)
- Joyce M Heutinck
- Department of Medical BioSciences, Radboud University Medical Center, Nijmegen, The Netherlands.
- Department of Industrial Design, Eindhoven University of Technology, Eindhoven, The Netherlands.
| | - Iris A de Koning
- Department of Medical BioSciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Tom Vromen
- Department of Cardiology, Maxima Medical Centre, Veldhoven, The Netherlands
| | - Dick H J Thijssen
- Department of Medical BioSciences, Radboud University Medical Center, Nijmegen, The Netherlands
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
| | - Hareld M C Kemps
- Department of Industrial Design, Eindhoven University of Technology, Eindhoven, The Netherlands
- Department of Cardiology, Maxima Medical Centre, Veldhoven, The Netherlands
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Gijón-Conde T, Ferré Sánchez C, Ibáñez Delgado I, Rodríguez Jiménez B, Banegas JR. Clinical profile of severe hypercholesterolemia in 156,000 adults in primary care. Clin Investig Arterioscler 2024; 36:1-11. [PMID: 37743130 DOI: 10.1016/j.arteri.2023.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 08/26/2023] [Accepted: 08/29/2023] [Indexed: 09/26/2023]
Abstract
OBJECTIVE To examine the frequency of severe hypercholesterolemia (HS) and its clinical profile, and the phenotype of familial hypercholesterolemia (FH), in the primary-care setting in a large health area of the Community of Madrid (CAM). MATERIAL AND METHODS Multicenter study of subjects with a health card assigned to 69 health centers (Northwest/CAM area). HS was defined as cholesterol ≥300mg/dL or LDL-cholesterol ≥220mg/dL in any analysis performed (1-1-2018 to 12-30-2021); and FH phenotype as c-LDL ≥240mg/dL (≥160mg/dL if lipid-lowering treatment) with triglycerides <200mg/dL and TSH <5μIU/mL. RESULTS 156,082 adults ≥18years with an available lipid profile were analyzed. 6187 subjects had HS (3.96% of the laboratory tests studied, 95%CI: 3.87-4.06%). The mean evolution time of the diagnosis of hyperlipidemia in the computerized clinical record was 10.8years, 36.5% had hypertension, 9.5% diabetes and 62.9% overweight/obesity. 83.7% were taking lipid-lowering drugs (65.7% low/moderate and 28.6% high/very high intensity). 6.1% had cardiovascular disease (94.2% treated with lipid-lowering agents), with LDL-cholesterol <55, <70 and <100mg/dL of 1.8%, 5.8% and 20.2%, respectively (vs. 1%, 2.3% and 11.2% if no cardiovascular disease). 1600 subjects had FH phenotype (95%CI: 1.03%, 0.98-1.08%). CONCLUSIONS Four out of 100 patients analyzed in primary care have HS, with high treatment level, but insufficient intensity, and poor achievement of treatment goals. One in 100 have the FH phenotype. The identification of both dyslipidemias by computerized records would allow their more precise and early detection and establish cardiovascular preventive strategies.
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Affiliation(s)
- Teresa Gijón-Conde
- Centro de Salud Universitario Cerro del Aire, Servicio Madrileño de Salud, Majadahonda, Madrid, España; Unidad Docente de Medicina de Familia, Departamento de Medicina, Universidad Autónoma de Madrid, Madrid, España; Asociación MAdrileña de Riesgo Enfermedad VAscular (AMAREVA), Madrid, España.
| | - Carolina Ferré Sánchez
- Centro de Salud Universitario Cerro del Aire, Servicio Madrileño de Salud, Majadahonda, Madrid, España
| | - Isabel Ibáñez Delgado
- Centro de Salud Universitario Cerro del Aire, Servicio Madrileño de Salud, Majadahonda, Madrid, España
| | | | - José R Banegas
- Departamento de Medicina Preventiva y Salud Pública, Universidad Autónoma de Madrid/Idi Paz; CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, España
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den Uijl I, Sunamura M, Brouwers RMW, Stam HJ, Boersma E, van den Berg-Emons RJG, Ter Hoeve N. Cardiac rehabilitation for patients with obesity: lessons learned from the OPTICARE XL trial. Neth Heart J 2024; 32:14-22. [PMID: 37982980 PMCID: PMC10781911 DOI: 10.1007/s12471-023-01832-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/19/2023] [Indexed: 11/21/2023] Open
Abstract
Obesity is a known and commonly encountered risk factor for the development of cardiac diseases. Patients with cardiac diseases who also have obesity do not benefit optimally from standard cardiac rehabilitation (CR) programs. Exercises performed during CR are not the best fit for patients with obesity and counselling sessions often do not address their specific needs. OPTICARE XL is the first large multicentre randomised controlled trial to investigate the added value of a dedicated one-year CR program specifically designed for patients with obesity and integrated in daily practice. The short-term effects on body weight and physical activity were promising and patients with obesity experienced the program as highly desirable. However, the OPTICARE XL CR program did not show long-term added value compared with standard CR on health-related quality of life, psychosocial well-being, body weight, physical activity and physical fitness, nor on costs. The current article offers an overview of the background of this trial and discusses the most important results of the OPTICARE XL trial and the reasons behind the unanticipated long-term outcomes. Furthermore, it offers recommendations for future research and how to redesign the OPTICARE XL CR program to expand the short-term results.
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Affiliation(s)
- Iris den Uijl
- Department of Rehabilitation Medicine, Erasmus University Medical Centre, Rotterdam, The Netherlands
- Capri Cardiac Rehabilitation, Rotterdam, The Netherlands
| | | | - Rutger M W Brouwers
- Department of Cardiology, Máxima Medical Centre, Eindhoven/Veldhoven, The Netherlands
| | - Henk J Stam
- Department of Rehabilitation Medicine, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Eric Boersma
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | | | - Nienke Ter Hoeve
- Department of Rehabilitation Medicine, Erasmus University Medical Centre, Rotterdam, The Netherlands.
- Capri Cardiac Rehabilitation, Rotterdam, The Netherlands.
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Lakušić N, Sopek Merkaš I. Quo vadis cardiac rehabilitation; the role of comprehensive cardiac rehabilitation in modern cardiology. World J Cardiol 2023; 15:627-632. [PMID: 38173904 PMCID: PMC10758603 DOI: 10.4330/wjc.v15.i12.627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 11/07/2023] [Accepted: 11/29/2023] [Indexed: 12/25/2023] Open
Abstract
In accordance with the guidelines established by prominent European and global cardiology associations, comprehensive cardiac rehabilitation (CR) stands as an officially endorsed and highly recommended therapeutic approach (class I recommendations; level of evidence A) for a diverse spectrum of cardiac patients. Nevertheless, it is a cause for concern to observe that fewer than 50% of eligible patients are being effectively referred for CR, whether in an outpatient or inpatient setting. Concurrently, studies reveal that a substantial proportion of individuals with atherosclerotic cardiovascular disease maintain unhealthy lifestyles and exhibit suboptimal management of modifiable cardiovascular risk factors, including hypertension, lipid levels, and diabetes. Beyond the conventional patient profile encompassing those recovering from acute coronary syndrome with or without percutaneous coronary intervention, as well as patients who have undergone coronary or valvular surgery, contemporary CR now emphasizes specialized subgroups of patients. These include frail elderly patients, the female population with its unique considerations, individuals burdened by multiple cardiovascular comorbidities, those who have developed psychological consequences due to a cardiac illness and particularly those grappling with chronic heart failure. This editorial seeks to offer a state-of-the-art assessment of the significance and role of comprehensive CR within modern cardiology.
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Affiliation(s)
- Nenad Lakušić
- Department of Cardiology, Special Hospital for Medical Rehabilitation Krapinske Toplice, Krapinske Toplice 49217, Croatia
- Department of Clinical Medicine, Faculty of Dental Medicine and Health Osijek, J. J. Strossmayer University of Osijek, Osijek 31000, Croatia
- Department of Internal Medicine, Family Medicine and History of Medicine, Faculty of Medicine Osijek, J. J. Strossmayer University of Osijek, Osijek 31000, Croatia
| | - Ivana Sopek Merkaš
- Department of Cardiology, Special Hospital for Medical Rehabilitation Krapinske Toplice, Krapinske Toplice 49217, Croatia.
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Marcos-Garcés V, Merenciano-González H, Martínez Mas ML, Palau P, Climent Alberola JI, Perez N, López-Bueno L, Esteban Argente MC, Valls Reig M, Muñoz Alcover R, Pradillas Contreras I, Arizón Benito A, Payá Rubio A, Ríos-Navarro C, de Dios E, Gavara J, Chorro FJ, Sanchis J, Bodi V. Short-Course High-Intensity Statin Treatment during Admission for Myocardial Infarction and LDL-Cholesterol Reduction-Impact on Tailored Lipid-Lowering Therapy at Discharge. J Clin Med 2023; 13:127. [PMID: 38202134 PMCID: PMC10780070 DOI: 10.3390/jcm13010127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 12/22/2023] [Accepted: 12/23/2023] [Indexed: 01/12/2024] Open
Abstract
We hypothesized that a short-course high-intensity statin treatment during admission for myocardial infarction (MI) could rapidly reduce LDL-C and thus impact the choice of lipid-lowering therapy (LLT) at discharge. Our cohort comprised 133 MI patients (62.71 ± 11.3 years, 82% male) treated with atorvastatin 80 mg o.d. during admission. Basal LDL-C levels before admission were analyzed. We compared lipid profile variables before and during admission, and LLT at discharge was registered. Achieved theoretical LDL-C levels were estimated using LDL-C during admission and basal LDL-C as references and compared to LDL-C on first blood sample 4-6 weeks after discharge. A significant reduction in cholesterol from basal levels was noted during admission, including total cholesterol, triglycerides, HDL-C, non-HDL-C, and LDL-C (-39.23 ± 34.89 mg/dL, p < 0.001). LDL-C levels were reduced by 30% in days 1-2 and 40-45% in subsequent days (R2 0.766, p < 0.001). Using LDL-C during admission as a reference, most patients (88.7%) would theoretically achieve an LDL-C < 55 mg/dL with discharge LLT. However, if basal LDL-C levels were considered as a reference, only a small proportion of patients (30.1%) would achieve this lipid target, aligned with the proportion of patients with LDL-C < 55 mg/dL 4-6 weeks after discharge (36.8%). We conclude that statin treatment during admission for MI can induce a significant reduction in LDL-C and LLT at discharge is usually prescribed using LDL-C during admission as the reference, which leads to insufficient LDL-C reduction after discharge. Basal LDL-C before admission should be considered as the reference value for tailored LLT prescription.
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Affiliation(s)
- Víctor Marcos-Garcés
- Department of Cardiology, Hospital Clinico Universitario de Valencia, 46010 Valencia, Spain; (H.M.-G.); (M.L.M.M.); (P.P.); (M.V.R.); (R.M.A.); (I.P.C.); (F.J.C.); (J.S.)
- INCLIVA Health Research Institute, 46010 Valencia, Spain; (N.P.); (C.R.-N.)
| | - Héctor Merenciano-González
- Department of Cardiology, Hospital Clinico Universitario de Valencia, 46010 Valencia, Spain; (H.M.-G.); (M.L.M.M.); (P.P.); (M.V.R.); (R.M.A.); (I.P.C.); (F.J.C.); (J.S.)
- INCLIVA Health Research Institute, 46010 Valencia, Spain; (N.P.); (C.R.-N.)
| | - María Luz Martínez Mas
- Department of Cardiology, Hospital Clinico Universitario de Valencia, 46010 Valencia, Spain; (H.M.-G.); (M.L.M.M.); (P.P.); (M.V.R.); (R.M.A.); (I.P.C.); (F.J.C.); (J.S.)
| | - Patricia Palau
- Department of Cardiology, Hospital Clinico Universitario de Valencia, 46010 Valencia, Spain; (H.M.-G.); (M.L.M.M.); (P.P.); (M.V.R.); (R.M.A.); (I.P.C.); (F.J.C.); (J.S.)
- INCLIVA Health Research Institute, 46010 Valencia, Spain; (N.P.); (C.R.-N.)
- Department of Medicine, Faculty of Medicine and Odontology, University of Valencia, 46010 Valencia, Spain
| | - Josefa Inés Climent Alberola
- Department of Rehabilitation, Hospital Clinico Universitario de Valencia, 46010 Valencia, Spain; (J.I.C.A.); (L.L.-B.); (M.C.E.A.); (A.P.R.)
| | - Nerea Perez
- INCLIVA Health Research Institute, 46010 Valencia, Spain; (N.P.); (C.R.-N.)
| | - Laura López-Bueno
- Department of Rehabilitation, Hospital Clinico Universitario de Valencia, 46010 Valencia, Spain; (J.I.C.A.); (L.L.-B.); (M.C.E.A.); (A.P.R.)
| | - María Concepción Esteban Argente
- Department of Rehabilitation, Hospital Clinico Universitario de Valencia, 46010 Valencia, Spain; (J.I.C.A.); (L.L.-B.); (M.C.E.A.); (A.P.R.)
| | - María Valls Reig
- Department of Cardiology, Hospital Clinico Universitario de Valencia, 46010 Valencia, Spain; (H.M.-G.); (M.L.M.M.); (P.P.); (M.V.R.); (R.M.A.); (I.P.C.); (F.J.C.); (J.S.)
| | - Raquel Muñoz Alcover
- Department of Cardiology, Hospital Clinico Universitario de Valencia, 46010 Valencia, Spain; (H.M.-G.); (M.L.M.M.); (P.P.); (M.V.R.); (R.M.A.); (I.P.C.); (F.J.C.); (J.S.)
| | - Inmaculada Pradillas Contreras
- Department of Cardiology, Hospital Clinico Universitario de Valencia, 46010 Valencia, Spain; (H.M.-G.); (M.L.M.M.); (P.P.); (M.V.R.); (R.M.A.); (I.P.C.); (F.J.C.); (J.S.)
| | | | - Alfonso Payá Rubio
- Department of Rehabilitation, Hospital Clinico Universitario de Valencia, 46010 Valencia, Spain; (J.I.C.A.); (L.L.-B.); (M.C.E.A.); (A.P.R.)
| | - César Ríos-Navarro
- INCLIVA Health Research Institute, 46010 Valencia, Spain; (N.P.); (C.R.-N.)
| | - Elena de Dios
- Network Biomedical Research Center for Cardiovascular Diseases (CIBER-CV), 28029 Madrid, Spain;
| | - Jose Gavara
- Centre for Biomaterials and Tissue Engineering, Universitat Politècnica de València, 46022 Valencia, Spain;
| | - Francisco Javier Chorro
- Department of Cardiology, Hospital Clinico Universitario de Valencia, 46010 Valencia, Spain; (H.M.-G.); (M.L.M.M.); (P.P.); (M.V.R.); (R.M.A.); (I.P.C.); (F.J.C.); (J.S.)
- INCLIVA Health Research Institute, 46010 Valencia, Spain; (N.P.); (C.R.-N.)
- Department of Medicine, Faculty of Medicine and Odontology, University of Valencia, 46010 Valencia, Spain
- Network Biomedical Research Center for Cardiovascular Diseases (CIBER-CV), 28029 Madrid, Spain;
| | - Juan Sanchis
- Department of Cardiology, Hospital Clinico Universitario de Valencia, 46010 Valencia, Spain; (H.M.-G.); (M.L.M.M.); (P.P.); (M.V.R.); (R.M.A.); (I.P.C.); (F.J.C.); (J.S.)
- INCLIVA Health Research Institute, 46010 Valencia, Spain; (N.P.); (C.R.-N.)
- Department of Medicine, Faculty of Medicine and Odontology, University of Valencia, 46010 Valencia, Spain
- Network Biomedical Research Center for Cardiovascular Diseases (CIBER-CV), 28029 Madrid, Spain;
| | - Vicente Bodi
- Department of Cardiology, Hospital Clinico Universitario de Valencia, 46010 Valencia, Spain; (H.M.-G.); (M.L.M.M.); (P.P.); (M.V.R.); (R.M.A.); (I.P.C.); (F.J.C.); (J.S.)
- INCLIVA Health Research Institute, 46010 Valencia, Spain; (N.P.); (C.R.-N.)
- Department of Medicine, Faculty of Medicine and Odontology, University of Valencia, 46010 Valencia, Spain
- Network Biomedical Research Center for Cardiovascular Diseases (CIBER-CV), 28029 Madrid, Spain;
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Burger PM, Dorresteijn JAN, Fiolet ATL, Koudstaal S, Eikelboom JW, Nidorf SM, Thompson PL, Cornel JH, Budgeon CA, Westendorp ICD, Beelen DPW, Martens FMAC, Steg PG, Asselbergs FW, Cramer MJ, Teraa M, Bhatt DL, Visseren FLJ, Mosterd A. Individual lifetime benefit from low-dose colchicine in patients with chronic coronary artery disease. Eur J Prev Cardiol 2023; 30:1950-1962. [PMID: 37409348 DOI: 10.1093/eurjpc/zwad221] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 05/30/2023] [Accepted: 07/04/2023] [Indexed: 07/07/2023]
Abstract
AIMS Low-dose colchicine reduces cardiovascular risk in patients with coronary artery disease (CAD), but absolute benefits may vary between individuals. This study aimed to assess the range of individual absolute benefits from low-dose colchicine according to patient risk profile. METHODS AND RESULTS The European Society of Cardiology (ESC) guideline-recommended SMART-REACH model was combined with the relative treatment effect of low-dose colchicine and applied to patients with CAD from the Low-Dose Colchicine 2 (LoDoCo2) trial and the Utrecht Cardiovascular Cohort-Second Manifestations of ARTerial disease (UCC-SMART) study (n = 10 830). Individual treatment benefits were expressed as 10-year absolute risk reductions (ARRs) for myocardial infarction, stroke, or cardiovascular death (MACE), and MACE-free life-years gained. Predictions were also performed for MACE plus coronary revascularization (MACE+), using a new lifetime model derived in the REduction of Atherothrombosis for Continued Health (REACH) registry. Colchicine was compared with other ESC guideline-recommended intensified (Step 2) prevention strategies, i.e. LDL cholesterol (LDL-c) reduction to 1.4 mmol/L and systolic blood pressure (SBP) reduction to 130 mmHg. The generalizability to other populations was assessed in patients with CAD from REACH North America and Western Europe (n = 25 812). The median 10-year ARR from low-dose colchicine was 4.6% [interquartile range (IQR) 3.6-6.0%] for MACE and 8.6% (IQR 7.6-9.8%) for MACE+. Lifetime benefit was 2.0 (IQR 1.6-2.5) MACE-free years, and 3.4 (IQR 2.6-4.2) MACE+-free life-years gained. For LDL-c and SBP reduction, respectively, the median 10-year ARR for MACE was 3.0% (IQR 1.5-5.1%) and 1.7% (IQR 0.0-5.7%), and the lifetime benefit was 1.2 (IQR 0.6-2.1) and 0.7 (IQR 0.0-2.3) MACE-free life-years gained. Similar results were obtained for MACE+ and in American and European patients from REACH. CONCLUSION The absolute benefits of low-dose colchicine vary between individual patients with chronic CAD. They may be expected to be of at least similar magnitude to those of intensified LDL-c and SBP reduction in a majority of patients already on conventional lipid-lowering and blood pressure-lowering therapy.
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Affiliation(s)
- Pascal M Burger
- Department of Vascular Medicine, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Jannick A N Dorresteijn
- Department of Vascular Medicine, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Aernoud T L Fiolet
- Department of Cardiology, University Medical Centre Utrecht, Utrecht, The Netherlands
- Dutch Cardiovascular Research Network (WCN), Moreelsepark 1, 3511 EP Utrecht, The Netherlands
| | - Stefan Koudstaal
- Dutch Cardiovascular Research Network (WCN), Moreelsepark 1, 3511 EP Utrecht, The Netherlands
- Department of Cardiology, Green Heart Hospital, Gouda, The Netherlands
| | | | - Stefan M Nidorf
- Department of Cardiology, GenesisCare Western Australia, Perth, Australia
- Heart Research Institute of Western Australia, Perth, Australia
| | - Peter L Thompson
- Department of Cardiology, GenesisCare Western Australia, Perth, Australia
- Heart Research Institute of Western Australia, Perth, Australia
| | - Jan H Cornel
- Dutch Cardiovascular Research Network (WCN), Moreelsepark 1, 3511 EP Utrecht, The Netherlands
- Department of Cardiology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Charley A Budgeon
- School of Population and Global Health, University of Western Australia, Perth, Australia
| | | | - Driek P W Beelen
- Department of Cardiology, IJsselland Hospital, Capelle aan den IJssel, The Netherlands
| | - Fabrice M A C Martens
- Dutch Cardiovascular Research Network (WCN), Moreelsepark 1, 3511 EP Utrecht, The Netherlands
- Department of Cardiology, Deventer Hospital, Deventer, The Netherlands
| | - Philippe Gabriel Steg
- Assistance Publique-Hôpitaux de Paris, Hôpital Bichat, Université de Paris, Paris, France
| | - Folkert W Asselbergs
- Department of Cardiology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Maarten J Cramer
- Department of Cardiology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Martin Teraa
- Department of Vascular Surgery, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Deepak L Bhatt
- Mount Sinai Heart, Icahn School of Medicine at Mount Sinai Health System, New York, USA
| | - Frank L J Visseren
- Department of Vascular Medicine, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Arend Mosterd
- Dutch Cardiovascular Research Network (WCN), Moreelsepark 1, 3511 EP Utrecht, The Netherlands
- Department of Cardiology, Meander Medical Centre, Maatweg 3, 3813 TZ Amersfoort, The Netherlands
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Brandts J, Tittel SR, Bramlage P, Danne T, Brix JM, Zimny S, Heyer CHJ, Holl RW, Müller-Wieland D. Low-density lipoprotein cholesterol and non-high-density lipoprotein cholesterol in type 1 diabetes and type 2 diabetes: Lipid goal attainment in a large German-Austrian diabetes registry. Diabetes Obes Metab 2023; 25:3700-3708. [PMID: 37694759 DOI: 10.1111/dom.15264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 08/11/2023] [Accepted: 08/17/2023] [Indexed: 09/12/2023]
Abstract
AIM To assess the implementation of the 2019 European Society of Cardiology (ESC)/European Atherosclerosis Society (EAS) guideline recommendations for lipid-lowering therapies among more than 30 000 patients with type 1 diabetes (T1D) and type 2 diabetes (T2D) in a German and Austrian registry from 2020 to 2022. MATERIALS AND METHODS Registry data from 2020 and 2021 of 32 170 adult patients (8314 patients with T1D and 23 856 with T2D) were stratified according to the 2019 ESC/EAS risk categories, and guideline-based low-density lipoprotein cholesterol (LDL-C) and non-high-density lipoprotein cholesterol (non-HDL-C) goal attainment was analysed. RESULTS In patients with T1D (median age 38.35 [20.51-57.13] years), overall statin use was 19.3%, ezetimibe use was 2.2% and the use of proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors or fibrates was less than 1%. In patients with T2D (median age 68.76 [58.86-78.39] years), 45.7% received statins, 3.4% received ezetimibe, and fibrates and PCSK9 inhibitors were used by 1% and 0.1%, respectively. Among patients with T1D, 6.16% reached their risk-based recommended LDL-C goal of less than 55 mg/dL (very high risk), 10.97% of less than 70 mg/dL (high risk), and 69.50% of less than 100 mg/dL (moderate risk), respectively. In patients with T2D, 11.81% reached their risk-based goal of LDL-C less than 55 mg/dL, 16.25% of less than 70 mg/dL, and 51.33% of less than 100 mg/dL. Non-HDL-C goals were reached more often, with 15.3%, 25.52% and 91.61% in patients with T1D and 18.56%, 17.96% and 82.30% in patients with T2D for very high, high and moderate risk, respectively. CONCLUSION Approximately 2 years after publication of the guidelines, LDL-C and non-HDL-C goal attainment was rarely achieved in patients with T1D and T2D with a high or very high cardiovascular risk.
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Affiliation(s)
- Julia Brandts
- Department of Medicine I, University Hospital Aachen, Aachen, Germany
- Imperial Centre for Cardiovascular Disease Prevention, Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, UK
| | - Sascha R Tittel
- Institute for Epidemiology and Medical Biometry, ZIBMT, University of Ulm, Ulm, Germany
- German Center for Diabetes Research (DZD), Munich, Germany
| | - Peter Bramlage
- Institute for Pharmacology and Preventive Medicine, Cloppenburg, Germany
| | - Thomas Danne
- Kinderkrankenhaus auf der Bult, Diabeteszentrum für Kinder und Jugendliche, Hannover, Germany
| | - Johanna M Brix
- Department of Medicine I, Vienna, Austria
- Karl Landsteiner Institute for obesity and metabolism, Vienna, Austria
| | - Stefan Zimny
- Department of General Internal Medicine, Endocrinology and Diabetes, HELIOS Clinic Schwerin, Schwerin, Germany
| | | | - Reinhard W Holl
- Institute for Epidemiology and Medical Biometry, ZIBMT, University of Ulm, Ulm, Germany
- German Center for Diabetes Research (DZD), Munich, Germany
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Galos G, Szabados E, Rabai M, Szalai R, Ferkai LA, Papp I, Toth K, Sandor B. Evaluation of Incidence and Risk Factors of Sudden Cardiac Death in Patients with Chronic Coronary Syndrome Attending Physical Training. Cardiol Ther 2023; 12:689-701. [PMID: 37803155 DOI: 10.1007/s40119-023-00331-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 09/04/2023] [Indexed: 10/08/2023] Open
Abstract
INTRODUCTION Regular physical activity is recommended to patients with chronic coronary syndrome (CCS). However, vigorous physical exercise occurs as a risk factor of sudden cardiac death (SCD). The effect of short-term and irregular exercise is controversial. The aim of this research is to assess the role of regular training in the incidence of SCD and to identify risk factors among patients with CCS participating in a long-term training program. METHODS Data of risk factors, therapy, and participation were collected retrospectively for a 10-year period, assessing the length and regularity of participation. The incidence of SCD and related mortality was registered. ANOVA, χ2 test, and multinominal logistic regression and stepwise analysis were performed. RESULTS The Incidence of chronic kidney disease (CKD) was higher (p < 0.01) and taking beta-blockers (BBs) was lower (p = 0.04) in the SCD group. Irregular training, lack of BBs, smoking, and CKD increased the risk of SCD, while female sex, angiotensin-converting enzyme inhibitors, angiotensin II receptor blockers (ACEI/ARBs), and BBs decreased the risk of SCD. CONCLUSIONS Taking ACEI/ARBs and BBs proved to be a protective factor, emphasizing the use of optimal medical therapy. Assessment of cardiac risk factors and control of comorbidities also proved to be important. The occurrence of SCD was connected to irregular physical activity, probably relating to the adverse effects of ad hoc exercising.
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Affiliation(s)
- Gergely Galos
- Division of Cardiology, 1st Department of Medicine, Medical School, University of Pecs, 7624, Pecs, Hungary
- Division of Preventive Cardiology and Rehabilitation, 1st Department of Medicine, Medical School, University of Pecs, 13 Ifjusag Str., Pecs, 7624, Hungary
| | - Eszter Szabados
- Division of Preventive Cardiology and Rehabilitation, 1st Department of Medicine, Medical School, University of Pecs, 13 Ifjusag Str., Pecs, 7624, Hungary
| | - Miklos Rabai
- Division of Cardiology, 1st Department of Medicine, Medical School, University of Pecs, 7624, Pecs, Hungary
| | - Rita Szalai
- Division of Cardiology, 1st Department of Medicine, Medical School, University of Pecs, 7624, Pecs, Hungary
- Division of Preventive Cardiology and Rehabilitation, 1st Department of Medicine, Medical School, University of Pecs, 13 Ifjusag Str., Pecs, 7624, Hungary
| | - Luca Anna Ferkai
- Doctoral School of Health Sciences, University of Pecs, 7621, Pecs, Hungary
| | - Ildiko Papp
- Division of Preventive Cardiology and Rehabilitation, 1st Department of Medicine, Medical School, University of Pecs, 13 Ifjusag Str., Pecs, 7624, Hungary
| | - Kalman Toth
- Division of Cardiology, 1st Department of Medicine, Medical School, University of Pecs, 7624, Pecs, Hungary
| | - Barbara Sandor
- Division of Preventive Cardiology and Rehabilitation, 1st Department of Medicine, Medical School, University of Pecs, 13 Ifjusag Str., Pecs, 7624, Hungary.
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Svavarsdóttir MH, Halapi E, Ketilsdóttir A, Ólafsdóttir IV, Ingadottir B. Changes in disease-related knowledge and educational needs of patients with coronary heart disease over a six-month period between hospital discharge and follow-up. Patient Educ Couns 2023; 117:107972. [PMID: 37703621 DOI: 10.1016/j.pec.2023.107972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 08/21/2023] [Accepted: 09/05/2023] [Indexed: 09/15/2023]
Abstract
OBJECTIVE To describe changes in the disease-related knowledge and educational needs of individuals with coronary heart disease (CHD). METHODS Patients hospitalized for CHD answered questionnaires about disease-related knowledge (Coronary Artery Disease Education Questionnaire-short version (CADE-Q-SV), score 0-20), educational needs (investigator-designed questions), health literacy (Short version of the European Health Literacy Survey Questionnaire (HLS-EU-Q16)), self-care (Self-Care of Coronary Heart Disease Inventory version (SC-CHDI)), and physical activity (Leisure-time Physical Activity Questionnaire) at discharge (T1) and six months later (T2). RESULTS Participants' (N = 308; mean [M] age=65.5 years [SD=8.7]; 81.5% male) knowledge scores increased from M= 13.8 (SD=3.2) to M= 14.8 (SD=2.8) (p < 0.001). At T1, educational level, age, health literacy, smoking, and self-care maintenance explained 14.5% of knowledge variability. At T2, these variables plus lack of awareness of CHD diagnosis explained 20.3% of the variability. Substantial educational needs were reported at both time points, although 89% received predischarge education. CONCLUSION The patients' educational needs were unfulfilled despite an increase in disease-related knowledge over time. Improved evidence-based patient education and follow-ups that address diagnosis, treatment, and self-care are needed. PRACTICE IMPLICATIONS Healthcare professionals can improve care of patients with CHD by providing focused patient education, prioritizing "need-to-know" topics and considering patients' health literacy.
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Affiliation(s)
| | - Eva Halapi
- University of Akureyri, Faculty of Nursing, Nordurslod 2, 600 Akureyri, Iceland
| | - Auður Ketilsdóttir
- Landspitali University Hospital, Hringbraut, 101 Reykjavik, Iceland; University of Iceland, Faculty of Nursing and Midwifery, Eiríksgata 34, 101 Reykjavik, Iceland
| | | | - Brynja Ingadottir
- Landspitali University Hospital, Hringbraut, 101 Reykjavik, Iceland; University of Iceland, Faculty of Nursing and Midwifery, Eiríksgata 34, 101 Reykjavik, Iceland
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Zuin M, Rigatelli G, Temporelli P, Di Fusco SA, Colivicchi F, Pasquetto G, Bilato C. Trends in acute myocardial infarction mortality in the European Union, 2012-2020. Eur J Prev Cardiol 2023; 30:1758-1771. [PMID: 37379577 DOI: 10.1093/eurjpc/zwad214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 06/21/2023] [Accepted: 06/26/2023] [Indexed: 06/30/2023]
Abstract
AIMS To assess the sex- and age-specific trends in acute myocardial infarction (AMI) mortality in the modern European Union (EU-27) member states between years 2012 and 2020. METHODS AND RESULTS Data on cause-specific deaths and population numbers by sex for each country of the EU-27 were retrieved through a publicly available European Statistical Office (EUROSTAT) dataset for the years 2012 to 2020. AMI-related deaths were ascertained when codes for AMI (ICD-10 codes I21.0-I22.0) were listed as the underlying cause of death in the medical death certificate. Deaths occurring before the age of 65 years were defined as premature deaths. To calculate annual trends, we assessed the average annual percent change (AAPC) with relative 95% confidence intervals (CIs) using joinpoint regression. During the study period, 1 793 314 deaths (1 048 044 males and 745 270 females) occurred in the EU-27 due to of AMI. The proportion of AMI-related deaths per 1000 total deaths decline from 5.0% to 3.5% both in the entire population (P for trend < 0.001) and in males or females, separately. Joinpoint regression analysis revealed a continuous linear decrease in age-adjusted AMI-related mortality from 2012 to 2020 among EU-27 members [AAPC: -4.6% (95% CI: -5.1 to -4.0), P < 0.001]. The age-adjusted mortality rate showed a plateau in some Eastern European countries and was more pronounced in EU-27 females and in subjects aged ≥65 years. CONCLUSION Over the last decade, the age-adjusted AMI-related mortality has been continuously declining in most of the in EU-27 member states. However, some disparities still exist between western and eastern European countries.
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Affiliation(s)
- Marco Zuin
- Department of Translational Medicine, University of Ferrara, Via Aldo Moro, 8, Ferrara 44100, Italy
- Department of Cardiology, West Vicenza Hospital, via del Parco 1, 30671, Arzignano, Italy
| | - Gianluca Rigatelli
- Department of Cardiology, Ospedali Riuniti Padova Sud, Via Albere 30, 35043, Monselice, Italy
| | - Pierluigi Temporelli
- Division of Cardiology, Istituti Clinici Scientifici Maugeri, IRCCS, via per Revislate 13, 28013, Gattico-Veruno, Italy
| | - Stefania Angela Di Fusco
- Clinical and Rehabilitation Cardiology Unit, San Filippo Neri Hospital, via Giovanni Martinotti 20, 00135 Rome, Italy
| | - Furio Colivicchi
- Clinical and Rehabilitation Cardiology Unit, San Filippo Neri Hospital, via Giovanni Martinotti 20, 00135 Rome, Italy
| | - Giampaolo Pasquetto
- Department of Cardiology, Ospedali Riuniti Padova Sud, Via Albere 30, 35043, Monselice, Italy
| | - Claudio Bilato
- Department of Cardiology, West Vicenza Hospital, via del Parco 1, 30671, Arzignano, Italy
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Carugo S, Sirtori CR, Gelpi G, Corsini A, Tokgozoglu L, Ruscica M. Updates in Small Interfering RNA for the Treatment of Dyslipidemias. Curr Atheroscler Rep 2023; 25:805-817. [PMID: 37792132 PMCID: PMC10618314 DOI: 10.1007/s11883-023-01156-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/17/2023] [Indexed: 10/05/2023]
Abstract
PURPOSE OF REVIEW Atherosclerotic cardiovascular disease (ASCVD) is still the leading cause of death worldwide. Despite excellent pharmacological approaches, clinical registries consistently show that many people with dyslipidemia do not achieve optimal management, and many of them are treated with low-intensity lipid-lowering therapies. Beyond the well-known association between low-density lipoprotein cholesterol (LDL-C) and cardiovascular prevention, the atherogenicity of lipoprotein(a) and the impact of triglyceride (TG)-rich lipoproteins cannot be overlooked. Within this landscape, the use of RNA-based therapies can help the treatment of difficult to target lipid disorders. RECENT FINDINGS The safety and efficacy of LDL-C lowering with the siRNA inclisiran has been documented in the open-label ORION-3 trial, with a follow-up of 4 years. While the outcome trial is pending, a pooled analysis of ORION-9, ORION-10, and ORION-11 has shown the potential of inclisiran to reduce composite major adverse cardiovascular events. Concerning lipoprotein(a), data of OCEAN(a)-DOSE trial with olpasiran show a dose-dependent drop in lipoprotein(a) levels with an optimal pharmacodynamic profile when administered every 12 weeks. Concerning TG lowering, although ARO-APOC3 and ARO-ANG3 are effective to lower apolipoprotein(apo)C-III and angiopoietin-like 3 (ANGPTL3) levels, these drugs are still in their infancy. In the era moving toward a personalized risk management, the use of siRNA represents a blossoming armamentarium to tackle dyslipidaemias for ASCVD risk reduction.
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Affiliation(s)
- S Carugo
- Department of Clinical Sciences and Community Health, Dyspnea Lab, Università degli Studi di Milano, Milan, Italy
- Department of Cardio-Thoracic-Vascular Diseases - Foundation IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - C R Sirtori
- Department of Pharmacological and Biomolecular Sciences, University of Milan, Milan, Italy
| | - G Gelpi
- Department of Cardio-Thoracic-Vascular Diseases - Foundation IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - A Corsini
- Department of Pharmacological and Biomolecular Sciences, University of Milan, Milan, Italy
| | - L Tokgozoglu
- Department of Cardiology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - M Ruscica
- Department of Cardio-Thoracic-Vascular Diseases - Foundation IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy.
- Department of Pharmacological and Biomolecular Sciences, University of Milan, Milan, Italy.
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Rocha JA, Azevedo LF, Freitas A, Cardoso JCS. Socioeconomic Inequalities and Predictors of Cardiac Rehabilitation Referral: Real-World Evidence. Am J Phys Med Rehabil 2023; 102:1020-1028. [PMID: 37126795 DOI: 10.1097/phm.0000000000002270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
OBJECTIVE The aim of the study is to identify factors associated with cardiac rehabilitation referral after an acute coronary syndrome at a university hospital. DESIGN We analyzed 2814 hospitalizations due to acute coronary syndrome between 2017 and 2019 in Centro Hospitalar São João. The hospital's morbidity database was used to retrieve patient information. Cardiac rehabilitation referral and participation were identified from administrative databases and clinical records. Socioeconomic data were obtained from municipality of residence-level data rather than patient-specific data. RESULTS Of 2814 hospitalizations, 72% (2028 cases) were eligible for cardiac rehabilitation. Mean age was 65.2 ± 13.4 yrs; 72% men, 33% diabetic, 57.1% hypertensive, and 63.6% dyslipidemic. Cardiac rehabilitation referral rate was low, at 18.8%, with 42 (11.0%) not attending cardiac rehabilitation and 39 (10.2%) dropping out. Females (odds ratio = 0.72 [95% confidence interval = 0.52-1.00]), older patients (odds ratio = 0.57 [0.42-0.77]; 55-64 vs. <55 yrs), and those coming from lower-income municipalities (odds ratio = 0.53 [0.41-0.69], below median vs. above median) with lower education level (odds ratio = 0.70 [0.54-0.92]; ≤4 vs. >4 yrs) were less likely to be referred to cardiac rehabilitation. CONCLUSIONS There is a need for new strategies to promote cardiac rehabilitation in disadvantaged groups, as sex, age, and socioeconomic inequities in access to cardiac rehabilitation remain unresolved.
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Affiliation(s)
- José Afonso Rocha
- From the Cardiovascular Rehabilitation Unit, Department of Physical Medicine and Rehabilitation, Centro Hospitalar Universitário São João, Porto, Portugal (JAR); Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto, Porto, Portugal (JAR); Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS) and Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto, Porto, Portugal (LFA, AF); Department of Cardiology, Centro Hospitalar Universitário São João, Porto, Portugal (JCSC); and Faculty of Medicine, University of Porto, Porto, Portugal (JCSC)
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Robson M, Riley S, Gagen E, McKeogh D. Love and lifestyle: how 'relational healthism' structures couples' talk of engagement with lifestyle advice associated with a new diagnosis of coronary heart disease. Psychol Health 2023; 38:1606-1622. [PMID: 35187996 DOI: 10.1080/08870446.2022.2033240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Revised: 12/17/2021] [Accepted: 01/11/2022] [Indexed: 10/19/2022]
Abstract
OBJECTIVES Healthy lifestyle change improves outcomes in coronary heart disease (CHD), but is rarely sustained. To better understand barriers to lifestyle change, we examined couples' talk of engaging with lifestyle advice after one partner receives a diagnosis of CHD. DESIGN A longitudinal qualitative design, in which a poststructuralist discourse analysis was performed on 35 interviews, conducted with 22 heterosexual British people in a long term relationship. The interviews occurred over three months after one partner was referred to a cardiac rehabilitation programme designed to support lifestyle change. RESULTS Couples understood their health as a shared practice underpinned by an ideological framework of healthism, creating a form of 'relational healthism'. Practicing relational healthism was not straightforward because the practices of surveillance, control, and discipline related to healthism often contravened relationship norms of support, acceptance and respect for the other's autonomy. Couples struggled to resolve this tension, dynamically adopting, resisting, and occasionally transforming discourses of health and love in ways that worked for and against engagement in lifestyle change. CONCLUSION In foregrounding the discursive and relational contexts of behavioural change engagement, we show the considerable complexity for couples, including costs related to engagement with lifestyle advice.
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Affiliation(s)
- Martine Robson
- Department of Psychology, Aberystwyth University, Aberystwyth, UK
| | - Sarah Riley
- School of Psychology, Massey University, Palmerston North, New Zealand
| | - Elizabeth Gagen
- Department of Geography, Aberystwyth University, Aberystwyth, UK
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Escobar C, Barrios V, Cequier A, Cosin-Sales J, Seijas J, Doblas JJG, Arrarte V, Tuñon J, Banach M. Impact of the Spanish consensus for improving lipid control on patients admitted for an acute coronary syndrome. J Clin Lipidol 2023; 17:756-764. [PMID: 37838521 DOI: 10.1016/j.jacl.2023.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Revised: 09/19/2023] [Accepted: 10/02/2023] [Indexed: 10/16/2023]
Abstract
INTRODUCTION In 2020, the Spanish Society of Cardiology published a consensus to improve lipid control in secondary prevention patients. This study was aimed to assess the impact of the implementation of this consensus in clinical practice. METHODS Non-interventional, national and multicenter study, with a prospective and retrospective design in two cohorts. Implementation of the consensus was performed on the prospective cohort. Prospective cohort included patients with acute coronary syndrome (ACS) from December 2020 to March 2022 and were followed-up for 3 months. Retrospective cohort included patients with ACS in the same hospital, matched for main baseline clinical characteristics, between August 2019 to February 2020, with a follow-up of 3 months. Additionally, patients were included if they had previously received lipid-lowering therapy and LDL cholesterol (LDL-C) was >55 mg/dL. RESULTS A total of 516 patients were included (245 in the prospective cohort and 271 in the retrospective cohort). Overall, mean age was 67.9 ± 11.4 years, 73.8 % were men, and 35.8 % had diabetes. At discharge, 98.4 % and 98.9 %, respectively (P = 0.71) were taking statins (90.6% vs 88.9 %; P = 0.564 high intensity statins), 58.4% vs 33.2 %; P<0.001 ezetimibe, 1.2% vs 0.4 %; P = 0.35 PCSK9 inhibitors. During the follow-up, the dose of statins was increased in 11.4% vs 3.3 % (P<0.001), and ezetimibe was added in 25.7% vs 25.8 % (P = 0.976). At study end, significantly more patients achieved LDL-C <55 mg/dL in the prospective cohort (45.6% vs 33.5 %; P = 0.013). CONCLUSIONS The implementation of the Spanish lipid consensus was associated with a significant improvement of LDL-C control after only 3 months.
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Affiliation(s)
| | | | - Angel Cequier
- University Hospital of Bellvitge, Barcelona, Spain (Dr Cequier)
| | - Juan Cosin-Sales
- Hospital Arnau de Vilanova, Cardiology, Valencia, Spain (Dr Cosin-Sales)
| | - Jose Seijas
- Complejo Hospitalario Universitario de Santiago de Compostela, A Coruña, Spain (Dr Seijas)
| | | | | | - Jose Tuñon
- Fundacion Jimenez Diaz, Madrid, Spain (Dr Tuñon)
| | - Maciej Banach
- Polish Mother's Memorial Hospital Research institute (PMMHRI), Lodz, Poland (Dr Banach)
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Jennings CS, Astin F, Prescott E, Hansen T, Gale Chris P, De Bacquer D. Illness perceptions and health literacy are strongly associated with health-related quality of life, anxiety, and depression in patients with coronary heart disease: results from the EUROASPIRE V cross-sectional survey. Eur J Cardiovasc Nurs 2023; 22:719-729. [PMID: 36351004 DOI: 10.1093/eurjcn/zvac105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 11/03/2022] [Accepted: 11/06/2022] [Indexed: 10/12/2023]
Abstract
AIMS To (1) Describe the sociodemographic and risk factor profiles of a sample of patients with coronary disease, (2) Explore associations between illness perceptions and health literacy with sociodemographic characteristics and risk factors, health-related quality of life (HRQoL), anxiety, and depression. METHODS AND RESULTS Conducted as part of the ESC Prevention of CVD Project and EUROASPIRE V survey, patients were consecutively and retrospectively identified 6 months to 2 years after an acute event or elective procedure from 12 countries and interviewed. Three thousand four hundred and eight participants (76% male, mean age 64 years) were recruited, 16% were smokers, 38% obese, 60% physically inactive, and 41% hypertensive. Forty percent had attended cardiac rehabilitation. More threatening illness perceptions were associated with female gender (P < 0.0001), lower income (P < 0.0001), lower education (P = 0.02), obesity (P < 0.0001), sedentary behaviour (P < 0.0001), and diabetes (P < 0.0001). Poorer health literacy was associated with obesity (P = 0.02) and sedentary behaviour (P = 0.0001). Threatening illness perceptions were strongly associated with anxiety, depression, and poorer ratings of HRQoL after multivariable adjustment (all P < 0.001). Poor health literacy was associated with anxiety and depression (P < 0.0001) and poorer ratings of HRQoL (HeartQol scores P = 0.03). Results were consistent across regions of Europe, age, gender, and socio-economic strata. CONCLUSIONS Interventions like cardiac rehabilitation should be targeted at vulnerable groups given the strong associations between more threatening illness perceptions, lower health literacy, lower HRQoL, and higher levels of anxiety and depression. The delivery and content of these interventions should be accessible for those with low health literacy.
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Affiliation(s)
- C S Jennings
- Honorary Professor of Nursing and Interdisciplinary Relations, National Institute for Prevention and Cardiovascular Health, University of Galway, Croí Heart & Stroke Centre, Croí House, Moyola Lane, Newcastle, Galway, H91 FF68, Ireland
| | - F Astin
- Professor of Nursing, School of Health, Wellbeing and Social Care, Faculty of Wellbeing, Education and Language Studies, The Open University, Horlock Building, Walton Hall, Milton Keynes, MK7 6AA, UK
| | - E Prescott
- Professor of Cardiology, Bispebjerg University Hospital, Copenhagen, Denmark
| | - T Hansen
- Zealand University Hospital, Denmark
| | - P Gale Chris
- Professor of Cardiovascular Medicine, Leeds Institute of Cardiovascular and Metabolic Medicine and Leeds Institute for Data Analytics, University of Leeds; Department of Cardiology, Leeds Teaching Hospitals NHS Trust, Level 11, Worsely Building, Leeds, UK
| | - D De Bacquer
- Professor of Epidemiology, Research Methodology and Biostatistics, Department of Public Health and Primary Care, Ghent University, C. Heymanslaan 10-4K3, 9000 Gent, Belgium
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Zhang S, Yin Z, Li ZF, Zhang WJ, Sui YG, Xu YL, Zhang HT, Liu XN, Qiu H, Zhao JL, Li JJ, Dou KF, Qian J, Wu NQ. The Effects of Sacubitril/Valsartan Compared to Olmesartan on the Blood Pressure and Glucolipid Metabolism in DM Patients with Primary Hypertension. Cardiovasc Drugs Ther 2023:10.1007/s10557-023-07509-1. [PMID: 37828149 DOI: 10.1007/s10557-023-07509-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/12/2023] [Indexed: 10/14/2023]
Abstract
PURPOSE Given the beneficial effects of sacubitril/valsartan on blood pressure generally, this study investigates its antihypertension effects in diabetes mellitus (DM) patients with primary hypertension specifically, and the effect of sacubitril/valsartan on glycolipid metabolism. METHODS We conducted a randomized, open-label, active-controlled study to compare the antihypertension effects of sacubitril/valsartan in DM individuals with primary hypertension. The primary end point was reduction in mean systolic blood pressure (SBP) from baseline with sacubitril/valsartan vs. olmesartan at week 8. The secondary endpoints included the changes in diastolic blood pressure (DBP), daytime SBP/DBP, nighttime SBP/DBP, BP achievement (office sitting BP < 130/80 mmHg), and lipid profile. The trial was registered with chictr.org.cn (ChiCTR2200066428) on Dec 22, 2022. RESULTS A total of 124 patients were included in the final analysis. SBP decreased to a greater extent in the sacubitril/valsartan group from baseline to 8 weeks [between-treatment difference: 3.51 mm Hg, 95% confidence interval (95% CI) 0.41 to 6.62 mm Hg, P = 0.03]. Furthermore, more patients achieved the blood pressure goal with sacubitril/valasartan (74.60% vs. 54.70%, P = 0.03). Multiple logistical regression analysis showed that sacubitril/valsartan was associated with BP achievement [odds ratio (OR) 0.33, 95% CI 0.14-0.73, P = 0.007], but the difference in SBP, DBP, day time SBP/DBP, and night time SBP/DBP reduction did not approach statistical significance. HbA1C1, total cholesterol, and low-density lipoprotein-cholesterol were lower than baseline in both groups (P < 0.05); however, there was no difference in the effects on glucose and lipid metabolism from sacubitril/valsartan compared to olmesartan. CONCLUSIONS Sacubitril/valsartan not only provided superior BP reduction compared to olmesartan, it did so without adverse effects on glycemic control and lipid parameters in DM patients with primary hypertension.
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Affiliation(s)
- Shuang Zhang
- Cardiometabolic Center, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Science and Peking Union Medical College, No 167 BeiLiShi Road, XiCheng District, Beijing, 100037, China
| | - Zheng Yin
- Cardiometabolic Center, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Science and Peking Union Medical College, No 167 BeiLiShi Road, XiCheng District, Beijing, 100037, China
| | - Zhi-Fan Li
- Cardiometabolic Center, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Science and Peking Union Medical College, No 167 BeiLiShi Road, XiCheng District, Beijing, 100037, China
| | - Wen-Jia Zhang
- Cardiometabolic Center, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Science and Peking Union Medical College, No 167 BeiLiShi Road, XiCheng District, Beijing, 100037, China
| | - Yong-Gang Sui
- Cardiometabolic Center, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Science and Peking Union Medical College, No 167 BeiLiShi Road, XiCheng District, Beijing, 100037, China
| | - Yan-Lu Xu
- Cardiometabolic Center, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Science and Peking Union Medical College, No 167 BeiLiShi Road, XiCheng District, Beijing, 100037, China
| | - Hai-Tao Zhang
- Cardiometabolic Center, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Science and Peking Union Medical College, No 167 BeiLiShi Road, XiCheng District, Beijing, 100037, China
| | - Xiao-Ning Liu
- Cardiometabolic Center, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Science and Peking Union Medical College, No 167 BeiLiShi Road, XiCheng District, Beijing, 100037, China
| | - Hong Qiu
- Cardiometabolic Center, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Science and Peking Union Medical College, No 167 BeiLiShi Road, XiCheng District, Beijing, 100037, China
| | - Jing-Lin Zhao
- Cardiometabolic Center, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Science and Peking Union Medical College, No 167 BeiLiShi Road, XiCheng District, Beijing, 100037, China
| | - Jian-Jun Li
- Cardiometabolic Center, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Science and Peking Union Medical College, No 167 BeiLiShi Road, XiCheng District, Beijing, 100037, China
| | - Ke-Fei Dou
- Cardiometabolic Center, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Science and Peking Union Medical College, No 167 BeiLiShi Road, XiCheng District, Beijing, 100037, China
| | - Jie Qian
- Cardiometabolic Center, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Science and Peking Union Medical College, No 167 BeiLiShi Road, XiCheng District, Beijing, 100037, China
| | - Na-Qiong Wu
- Cardiometabolic Center, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Science and Peking Union Medical College, No 167 BeiLiShi Road, XiCheng District, Beijing, 100037, China.
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Zhang K, Ma Y, Luo Y, Song Y, Xiong G, Ma Y, Sun X, Kan C. Metabolic diseases and healthy aging: identifying environmental and behavioral risk factors and promoting public health. Front Public Health 2023; 11:1253506. [PMID: 37900047 PMCID: PMC10603303 DOI: 10.3389/fpubh.2023.1253506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 10/03/2023] [Indexed: 10/31/2023] Open
Abstract
Aging is a progressive and irreversible pathophysiological process that manifests as the decline in tissue and cellular functions, along with a significant increase in the risk of various aging-related diseases, including metabolic diseases. While advances in modern medicine have significantly promoted human health and extended human lifespan, metabolic diseases such as obesity and type 2 diabetes among the older adults pose a major challenge to global public health as societies age. Therefore, understanding the complex interaction between risk factors and metabolic diseases is crucial for promoting well-being and healthy aging. This review article explores the environmental and behavioral risk factors associated with metabolic diseases and their impact on healthy aging. The environment, including an obesogenic environment and exposure to environmental toxins, is strongly correlated with the rising prevalence of obesity and its comorbidities. Behavioral factors, such as diet, physical activity, smoking, alcohol consumption, and sleep patterns, significantly influence the risk of metabolic diseases throughout aging. Public health interventions targeting modifiable risk factors can effectively promote healthier lifestyles and prevent metabolic diseases. Collaboration between government agencies, healthcare providers and community organizations is essential for implementing these interventions and creating supportive environments that foster healthy aging.
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Affiliation(s)
- Kexin Zhang
- Department of Endocrinology and Metabolism, Affiliated Hospital of Weifang Medical University, School of Clinical Medicine, Weifang Medical University, Weifang, China
- Clinical Research Center, Affiliated Hospital of Weifang Medical University, Weifang, China
| | - Yujie Ma
- Department of Pathophysiology, School of Basic Medical Sciences, Weifang Medical University, Weifang, China
| | - Youhong Luo
- Department of Endocrinology and Metabolism, Affiliated Hospital of Weifang Medical University, School of Clinical Medicine, Weifang Medical University, Weifang, China
- Clinical Research Center, Affiliated Hospital of Weifang Medical University, Weifang, China
| | - Yixin Song
- Department of Endocrinology and Metabolism, Affiliated Hospital of Weifang Medical University, School of Clinical Medicine, Weifang Medical University, Weifang, China
- Clinical Research Center, Affiliated Hospital of Weifang Medical University, Weifang, China
| | - Guoji Xiong
- Department of Endocrinology and Metabolism, Affiliated Hospital of Weifang Medical University, School of Clinical Medicine, Weifang Medical University, Weifang, China
- Clinical Research Center, Affiliated Hospital of Weifang Medical University, Weifang, China
| | - Yanhui Ma
- Department of Pathology, Affiliated Hospital of Weifang Medical University, Weifang, China
| | - Xiaodong Sun
- Department of Endocrinology and Metabolism, Affiliated Hospital of Weifang Medical University, School of Clinical Medicine, Weifang Medical University, Weifang, China
- Clinical Research Center, Affiliated Hospital of Weifang Medical University, Weifang, China
| | - Chengxia Kan
- Department of Endocrinology and Metabolism, Affiliated Hospital of Weifang Medical University, School of Clinical Medicine, Weifang Medical University, Weifang, China
- Clinical Research Center, Affiliated Hospital of Weifang Medical University, Weifang, China
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Byrne RA, Rossello X, Coughlan JJ, Barbato E, Berry C, Chieffo A, Claeys MJ, Dan GA, Dweck MR, Galbraith M, Gilard M, Hinterbuchner L, Jankowska EA, Jüni P, Kimura T, Kunadian V, Leosdottir M, Lorusso R, Pedretti RFE, Rigopoulos AG, Rubini Gimenez M, Thiele H, Vranckx P, Wassmann S, Wenger NK, Ibanez B. 2023 ESC Guidelines for the management of acute coronary syndromes. Eur Heart J 2023; 44:3720-3826. [PMID: 37622654 DOI: 10.1093/eurheartj/ehad191] [Citation(s) in RCA: 309] [Impact Index Per Article: 309.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/26/2023] Open
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Patterson K, Davey R, Keegan R, Niyonsenga T, Mohanty I, Bowen S, Regan E, Lander M, van Berlo S, Freene N. Testing the Effect of a Smartphone App on Hospital Admissions and Sedentary Behavior in Cardiac Rehabilitation Participants: ToDo-CR Randomized Controlled Trial. JMIR Mhealth Uhealth 2023; 11:e48229. [PMID: 37788043 PMCID: PMC10582808 DOI: 10.2196/48229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 07/04/2023] [Accepted: 08/16/2023] [Indexed: 10/04/2023] Open
Abstract
BACKGROUND People with coronary heart disease are at an increased risk of morbidity and mortality even if they attend cardiac rehabilitation. High sedentary behavior levels potentially contribute to this morbidity. Smartphone apps may be feasible to facilitate sedentary behavior reductions and lead to reduced health care use. OBJECTIVE We aimed to test the effect of a sedentary behavior change smartphone app (Vire app and ToDo-CR program) as an adjunct to cardiac rehabilitation on hospital admissions and emergency department (ED) presentations over 12 months. METHODS A multicenter, randomized controlled trial was conducted with 120 participants recruited from 3 cardiac rehabilitation programs. Participants were randomized 1:1 to cardiac rehabilitation plus the fully automated 6-month Vire app and ToDo-CR program (intervention) or usual care (control). The primary outcome was nonelective hospital admissions and ED presentations over 12 months. Secondary outcomes including accelerometer-measured sedentary behavior, BMI, waist circumference, and quality of life were recorded at baseline and 6 and 12 months. Logistic regression models were used to analyze the primary outcome, and linear mixed-effects models were used to analyze secondary outcomes. Data on intervention and hospital admission costs were collected, and the incremental cost-effectiveness ratios (ICERs) were calculated. RESULTS Participants were, on average, aged 62 (SD 10) years, and the majority were male (93/120, 77.5%). The intervention group were more likely to experience all-cause (odds ratio [OR] 1.54, 95% CI 0.58-4.10; P=.39) and cardiac-related (OR 3.26, 95% CI 0.84-12.55; P=.09) hospital admissions and ED presentations (OR 2.07, 95% CI 0.89-4.77; P=.09) than the control group. Despite this, cardiac-related hospital admission costs were lower in the intervention group over 12 months (Aus $252.40 vs Aus $859.38; P=.24; a currency exchange rate of Aus $1=US $0.69 is applicable). There were no significant between-group differences in sedentary behavior minutes per day over 12 months, although the intervention group completed 22 minutes less than the control group (95% CI -22.80 to 66.69; P=.33; Cohen d=0.21). The intervention group had a lower BMI (β=1.62; P=.05), waist circumference (β=5.81; P=.01), waist-to-hip ratio (β=.03, P=.03), and quality of life (β=3.30; P=.05) than the control group. The intervention was more effective but more costly in reducing sedentary behavior (ICER Aus $351.77) and anxiety (ICER Aus $10,987.71) at 12 months. The intervention was also more effective yet costly in increasing quality of life (ICER Aus $93,395.50) at 12 months. CONCLUSIONS The Vire app and ToDo-CR program was not an outcome-effective or cost-effective solution to reduce all-cause hospital admissions or ED presentations in cardiac rehabilitation compared with usual care. Smartphone apps that target sedentary behavior alone may not be an effective solution for cardiac rehabilitation participants to reduce hospital admissions and sedentary behavior. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12619001223123; https://australianclinicaltrials.gov.au/anzctr/trial/ACTRN12619001223123. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.1136/bmjopen-2020-040479.
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Affiliation(s)
- Kacie Patterson
- Health Research Institute, Faculty of Health, University of Canberra, Bruce, ACT, Australia
| | - Rachel Davey
- Health Research Institute, Faculty of Health, University of Canberra, Bruce, ACT, Australia
| | - Richard Keegan
- Research Institute for Sports and Exercise (UCRISE), Faculty of Health, University of Canberra, Bruce, ACT, Australia
| | - Theo Niyonsenga
- Health Research Institute, Faculty of Health, University of Canberra, Bruce, ACT, Australia
| | - Itismita Mohanty
- Health Research Institute, Faculty of Health, University of Canberra, Bruce, ACT, Australia
| | - Sarah Bowen
- National Capital Private Hospital, Garran, ACT, Australia
| | | | | | | | - Nicole Freene
- Health Research Institute, Faculty of Health, University of Canberra, Bruce, ACT, Australia
- Physiotherapy, Faculty of Health, University of Canberra, Bruce, ACT, Australia
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Guan C, Wu S, Xu W, Zhang J. Global, regional, and national burden of ischaemic heart disease and its trends, 1990-2019. Public Health 2023; 223:57-66. [PMID: 37604031 DOI: 10.1016/j.puhe.2023.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 07/06/2023] [Accepted: 07/06/2023] [Indexed: 08/23/2023]
Abstract
OBJECTIVES Ischemic heart disease (IHD) has high morbidity, disability, and mortality rates and is a major contributor to the global disease burden. This study aimed to obtain a more detailed description of the burden of IHD through secondary analysis of data from the Global Burden of Disease (GBD) 2019. STUDY DESIGN This is an epidemiological study. METHODS Data for this study were obtained from the GBD 2019 database. Annual average percentage change (AAPC) was calculated to assess trends in IHD prevalence, morbidity, mortality, and disability-adjusted life years (DALYs). Regional and national burden of IHD was assessed by stratifying by sex, age, and socio-demographic index (SDI). RESULTS From 1990 to 2019, the global prevalence of IHD, morbidity cases, deaths, and DALYs increased, but the age-standardized rates of IHD burden decreased. Morbidity, mortality, and DALY rates for IHD in both sexes increased with age. The prevalence, incidence, mortality, and DALY rates were higher in men than women in all age groups. In particular, the male-to-female ratios for mortality and DALY rates peaked among 35-39 year olds, while the male-to-female ratios for prevalence and morbidity peaked among 55-59 year olds. Age-standardized prevalence, incidence, and DALY rates were higher in low- and middle-income regions than in other SDI regions. CONCLUSION Although age-standardized prevalence, morbidity, mortality, and age-standardized DALY rates due to IHD decreased globally from 1990 to 2019, age-standardized prevalence and morbidity of IHD increased in Low SDI, Low-middle SDI, and Middle SDI regions.
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Affiliation(s)
- Chengfu Guan
- Department of Pharmacy, Fujian Maternity and Child Health Hospital College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
| | - Shuyi Wu
- Department of Pharmacy, Fujian Maternity and Child Health Hospital College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
| | - Wenlin Xu
- Department of Pharmacy, Fujian Maternity and Child Health Hospital College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
| | - Jinhua Zhang
- Department of Pharmacy, Fujian Maternity and Child Health Hospital College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China.
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