Additional Physical Activity During Cardiac Rehabilitation Leads to an Improved Heart Rate Recovery in Male Patients After Coronary Artery Bypass Grafting

Barriers and Facilitators to Delivering Inpatient Cardiac Rehabilitation: A Scoping Review

Objective

The purpose of this scoping review was to summarize the literature on barriers and facilitators that influence the provision and uptake of inpatient cardiac rehabilitation (ICR).

Methods

A literature search was conducted using PsycINFO, MEDLINE, EMBASE, CINAHL and AgeLine. Studies were included if they were published in English after the year 2000 and focused on adults who were receiving some form of ICR (eg, exercise counselling and training, education for heart-healthy living). For studies meeting inclusion criteria, descriptive data on authors, year, study design, and intervention type were extracted.

Results

The literature search resulted in a total of 44,331 publications, of which 229 studies met inclusion criteria. ICR programs vary drastically and often focus on promoting physical exercises and patient education. Barriers and facilitators were categorized through patient, provider and system level factors. Individual characteristics and provider knowledge and efficacy were categorized as both barriers and facilitators to ICR delivery and uptake. Team functioning, lack of resources, program coordination, and inconsistencies in evaluation acted as key barriers to ICR delivery and uptake. Key facilitators that influence ICR implementation and engagement include accreditation and professional associations and patient and family-centred practices.

Conclusion

ICR programs can be highly effective at improving health outcomes for those living with CVDs. Our review identified several patient, provider, and system-level considerations that act as barriers and facilitators to ICR delivery and uptake. Future research should explore how to encourage health promotion knowledge amongst ICR staff and patients.

Exercise training and cardiac autonomic function following coronary artery bypass grafting: a systematic review and meta-analysis

BACKGROUND

Exercise training improves cardiac autonomic function is still debatable in patients with coronary artery bypass grafting (CABG). The aim of the present review is to assess the effect of exercise on CABG patient's heart rate variability (HRV) and heart rate recovery (HRR) parameters.

MAIN BODY

Databases (PubMed, Web of Science and PEDro) were accessed for systematic search from inception till May 2022. Eleven potential studies were qualitatively analyzed by using PEDro and eight studies were included in the quantitative synthesis. Meta-analysis was conducted by using a random-effect model, inverse-variance approach through which standardized mean differences (SMDs) were estimated. The analysis of pooled data showed that exercise training improved HRV indices of standard deviation of the R-R intervals (SDNN) [SMD 0.44, 95% CI 0.17, 0.71, p = 0.002], square root of the mean squared differences between adjacent R-R intervals (RMSSD) [SMD 0.68, 95% CI 0.28, 1.08, p = 0.0008], high frequency (HF) [SMD 0.58, 95% CI 0.18, 0.98, p = 0.005] and low frequency-to-high frequency (LF/HF) ratio [SMD - 0.34, 95% CI - 0.65, - 0.02, p = 0.03].

CONCLUSIONS

Exercise training enhances cardiac autonomic function in CABG patients. Owing to the methodological inconsistencies in assessing HRV, the precise effect on autonomic function still remains conflicted. Future high-quality trials are needed focusing on precise methodological approach and incorporation of various types of exercise training interventions will give clarity regarding autonomic adaptations post-exercise training in CABG. Trial registration CRD42021230270 , February 19, 2021.

Cardiac physiology in post myocardial infarction patients: the effect of cardiac rehabilitation programs-a systematic review and update meta-analysis

Cardiac rehabilitation program (CRP) is a recognized non-pharmacological modality to decrease mortality after acute myocardial infarction (AMI) events. We aimed to evaluate the effect of CRP on the cardiac physiology in patients post myocardial infarction (MI). Online database search of PubMed, MEDLINE, EMBASE, SCOPUS, COCHRANE, and GOOGLE SCHOLAR were performed (1988-Mar 2016); key bibliographies were reviewed. Studies comparing post MI patients who were enrolled in a CRP to those who were not, were included. Standardized mean difference (SMD) with the corresponding 95% confidence intervals (CI) by random and fixed effects models of pooled data were calculated. Study quality was assessed using CONSORT criteria. Outcomes of interest measured included resting and maximum heart rate (HR), peak VO₂, ejection fraction (EF%), wall motion score index (WMSI), left ventricular end diastolic volume (LVEDV) in cardiac rehabilitation patients versus control. Search strategy yielded 147 studies, 23 studies fulfilled the selection criteria, 19 of which were RCTs. These included a total of 1,683 patients; 827 were enrolled in a CRP while 855 did not receive the intervention. Median age was 58 years. There was no significant difference between the two groups in terms of age, comorbidities, severity of CAD, baseline EF or HR. Meta-analysis of data included demonstrated that CRP patients had lower post-intervention resting HR than non-CRP patients (SMD: -0.59; 95% CI: -0.73 to -0.46, fixed effect model P<0.05). EF% was significantly improved after CRP compared to control (SMD: 0.21; 95% CI: 0.02 to 0.40, P=0.03). Peak VO₂ was significantly improved by CRP (SMD: 1.00; 95% CI: 0.56 to 1.45; P<0.0001). LVEDV was significantly less in CRP patients (SMD: -0.31; 95% CI: -0.59 to -0.02, fixed effect model P<0.05). WMSI was significantly less in CRP patients (SMD: -0.41; 95% CI: -0.78 to -0.05, P=0.024). CRP improves cardiac function in post MI patients. This may explain the reported improvement of functionality and mortality among those patients. Further randomized trials may help evaluate the long-term benefits of CRP.

Heritability of heart rate recovery and vagal rebound after exercise

Purpose

The prognostic power of heart rate recovery (HRR) after exercise has been well established but the exact origin of individual differences in HRR remains unclear. This study aims to estimate the heritability of HRR and vagal rebound after maximal exercise in adolescents. Furthermore, the role of voluntary regular exercise behavior (EB) in HRR and vagal rebound is tested.

Methods

491 healthy adolescent twins and their siblings were recruited for maximal exercise testing, followed by a standardized cooldown with measurement of the electrocardiogram and respiratory frequency. Immediate and long-term HRR (HRR60 and HRR180) and vagal rebound (heart rate variability in the respiratory frequency range) were assessed 1 and 3 min after exercise. Multivariate twin modeling was used to estimate heritability of all measured variables and to compute the genetic contribution to their covariance.

Results

Heritability of HRR60, HRR180 and immediate and long-term vagal rebound is 60 % (95 % CI: 48–67), 65 % (95 % CI: 54–73), 23 % (95 % CI: 11–35) and 3 % (95 % CI: 0–11), respectively. We find evidence for two separate genetic factors with one factor influencing overall cardiac vagal control, including resting heart rate and respiratory sinus arrhythmia, and a specific factor for cardiac vagal exercise recovery. EB was only modestly associated with resting heart rate (r = −0.27) and HRR (rHRR60 = 0.10; rHRR180 = 0.19) with very high genetic contribution to these associations (88–91 %).

Conclusions

Individual differences in HRR and immediate vagal rebound can to a large extent be explained by genetic factors. These innate cardiac vagal exercise recovery factors partly reflect the effects of heritable differences in EB.

Heart rate recovery, cardiac rehabilitation and erectile dysfunction in males with ischaemic heart disease

Objective:

Heart rate recovery (HRR) is a recognised marker used in clinical practice for assessing the risk of sudden cardiac death. Physical exercise leads to an improvement in HRR and has a proven beneficial effect on erection quality (EQ) related to the activity of the autonomic nervous system in men with ischaemic heart disease (IHD). This paper evaluates the relationship between HRR and EQ in patients with IHD and erectile dysfunction (ED) who underwent cardiac rehabilitation.

Methods:

The main analysis was based on the Mann–Whitney U test, Wilcoxon signed-rank test, Spearman correlation coefficient, Pearson’s chi-square test, chi-square test, with the Yates correction and (if possible) parametric tests were used. This prospective, non-randomised intervention study included 124 men with IHD and ED [International Index of Erectile Function (IIEF-5) scores of ≤21]. Of these, 89 patients underwent a 6-month cardiac rehabilitation phase III programme, whereas 35 did not. The results of the participants’ total IIEF-5 scores and their HRR, demographic and clinical data were analysed.

Results:

The results of the 89 rehabilitated patients (mean age: 60.44±9.29 years) and 35 controls (mean age: 61.43±8.81 years) were analysed. In the rehabilitated patients, the mean baseline IIEF-5 score was 13.15±5.76 (95% CI: 11.93–14.36) and HRR was 16.49±7.68/min (95% CI: 14.88–18.11). After cardiac rehabilitation, the parameters of ED and HRR improved significantly and were significantly higher than those of the controls; the mean IIEF-5 score of the rehabilitated group increased to 15.36±6.51 (95% CI: 13.99–16.73), while HRR increased to 21.40±7.25/min (95% CI: 19.88–22.93). A significant correlation was found between ∆HRR and ∆EQ (r=0.409791) as a result of the 6-month cardiac training programme

Conclusion:

Cardiac rehabilitation assessed by HRR has a sizable effect on autonomic balance in patients with IHD and ED, which plays a significant role in the mechanism of erection improvement.

The influence of endurance training intensity on dynamics of post-exertional heart rate recovery adaptation in patients with ischemic heart disease

PURPOSE

The intensity of post-exertion heart rate recovery, evaluated in the first minute of the recovery period (HRR₆₀), is considered to be a strong predictor of risk for cardiac death. Intensification of physical activity performed as part of cardiac rehabilitation (CR) increases the HRR₆₀ value in ischemic heart disease (IHD) patients. In this context, the impact of endurance training intensity (ETI) on change in HRR₆₀ intensity seems to be an interesting issue.

MATERIAL/METHODS

The study group consisted of 251 patients who were subjected to a CR cycle. 45 patients of this group participated in CR twice. The control group consisted of 35 patients who were not subjected to any CR. ETI was estimated by the training work. In all patients an exertion test on a treadmill was performed twice within six months, analyzing the initial and final HRR₆₀ value and ΔHRR₆₀.

RESULTS

After a six-month observation, there was a statistically significant increase in the HRR₆₀ value (17.98±8.33/min vs. 22.72±7.72/min, p<0.01) in the test group, which was not observed in the control group. Mean ΔHRR₆₀ value in the test group was statistically significantly greater than in the control group. In the subgroup subjected to the two CR cycles, only the first cycle led to a statistically significant increase in the mean HRR₆₀ value.

CONCLUSIONS

A six-month CR cycle significantly increased the HRR₆₀ value, while cardiac training intensity did not affect the exertion-evoked change in its intensity. Continuation of the CR cycle beyond 6 months no longer significantly affected the change in the HRR₆₀ value.

Health-related quality of life in patients with coronary heart disease after residential vs ambulatory cardiac rehabilitation

BACKGROUND

The aim of this study was to evaluate the influence of residential (RCR) vs ambulatory (ACR) cardiac rehabilitation (CR) on health-related quality of life (QOL) connected with changes in exercise capacity of patients with coronary heart disease (CHD).

METHODS AND RESULTS

The 562 patients with CHD were studied: 313 participants in RCR and 249 participants in ACR. The examination was performed at the beginning of CR and after 8 weeks. QOL was assessed using the EuroQuol 5D (EQ-5D) and SF36 questionnaires. Exercise testing was performed with evaluation of workload during the last stage of the test and rate of perceived exertion intensity. In the first examination, patients from both groups did not differ significantly. After 8 weeks, a similar improvement in QOL was observed in both settings of CR according to EQ-5D and SF36 results. Health status was improved by 11.1% in the RCR group and by 10.4% in the ACR group. Last workload's intensity increased significantly by 32.1% in the RCR group and by 38.1% in the ACR group. The rate of perceived exertion intensity did not change despite the bigger workloads during the exercise test.

CONCLUSIONS

Comprehensive CR improves health-related QOL and exercise capacity without differences between residential and ambulatory models.

Ratio of Early Transmitral Velocity to Lateral Mitral Annular Early Diastolic Velocity Has the Best Correlation With Wedge Pressure Following Cardiac Surgery

BACKGROUND

Although previous investigators reported that mitral annular velocity predicts mean pulmonary capillary wedge pressure (PCWP), it is unknown whether the lateral or septal mitral annular velocity more faithfully predicts PCWP after cardiac surgery.

METHODS AND RESULTS

To assess the effect of cardiac surgery on the predictive values for PCWP by measuring mitral annular velocity, 52 consecutive patients undergoing cardiac surgery were studied. All patients underwent transthoracic echocardiography and right-sided cardiac catheterization both before and after surgery. The peak early diastolic velocity of transmitral flow (E) was measured by pulsed-wave Doppler and the peak early diastolic velocities of the lateral (LEa) and septal (SEa) mitral annulus by pulsed-wave tissue Doppler imaging. The ratios of E to LEa (E/LEa) and SEa (E/SEa) were calculated. Immediately after echocardiography, PCWP was measured using a balloon-tipped pulmonary artery catheter. After surgery, LEa was significantly increased (6.4+/-2.7 vs 8.6+/-3.3 cm/s, p<0.001), but SEa was unchanged (6.0+/-2.5 vs 5.5+/-2.3 cm/s, p=0.09). E/LEa correlated well with PCWP both before and after surgery (r=0.79 and r=0.69, respectively, p<0.001). Although E/SEa correlated well before surgery (r=0.67, p<0.001), it correlated only weakly after surgery (r=0.44, p<0.01).

CONCLUSIONS

E/LEa has the best correlation with PCWP both before and after cardiac surgery and may be more useful than E/SEa in the noninvasive estimation of PCWP.