Current exercise-based rehabilitation impacts on poststroke exercise capacity, blood pressure, and lipid control: a meta-analysis

Objectives

This systematic review aimed to evaluate the impact of post-stroke exercise-based rehabilitation programs on blood pressure, lipid profile, and exercise capacity.

Methods

Through a systemic search of literature from inception to 2024 using five databases, we analyzed data on the mean difference (MD) using a meta-analysis method to estimate effectiveness.

Results

Thirty-seven randomized control trials were included encompassing various exercises such as aerobic, resistance, stretching, exergaming, robot-assisted training, and community-based training. Significant improvement was illustrated at discharge in systolic [MD 2.76 mmHg; 95% confidence interval (CI) -1.58 to 3.92, P < 0.05] and diastolic (MD 1.28 mmHg; 95% CI 0.54-2.12, P < 0.05) blood pressure and peak oxygen volume (MD -0.29 ml/kg/min; 95% CI -0.53 to 0.05, P < 0.05). We also observed significant improvement at discharge in high-density lipoprotein only after resistance exercise from two articles and low-density lipoprotein only in the intervention groups compared to the control groups from ten articles.

Conclusion

Overall, current exercise-based rehabilitation programs significantly improve blood pressure and exercise capacity in patients with stroke at discharge. However, lipoprotein changes remained inconclusive. Although ameliorative changes were noted in most variables, more research is needed to determine optimum exercise intensity, type combination, and health education to reduce post-stroke complications and mortality.

Systematic Review Registration

https://doi.org/10.17605/OSF.IO/X89FW.

The predictive value of monocyte count to high-density lipoprotein cholesterol ratio combined with left atrial diameter for post-radiofrequency ablation recurrence of paroxysmal atrial fibrillation in patients

BACKGROUND

Paroxysmal atrial fibrillation (PAF) usually recurs after radiofrequency ablation (RFA). This study probed the predictive value of monocyte count to high-density lipoprotein cholesterol (HDL-C) ratio (MHR) with left atrial diameter (LAD) for post-RFA recurrence in PFA patients.

METHODS

Totally 210 RFA-treated PAF patients were selected and assigned into Recurrence and Non-Recurrence groups, with clinical baseline data recorded. Preoperative HDL-C, hypersensitive C-reactive protein, interleukin-6, tumor necrosis factor alpha, brain natriuretic peptide, low-density lipoprotein cholesterol, total cholesterol, and total cholesterol were determined. Monocyte count and MHR were examined. The effects of preoperative MHR and LAD on post-RFA PAF recurrence was analyzed by COX regression analysis. Patients were arranged into high and low MHR and high and low LAD groups. The recurrence of PAF patients with different preoperative MHR and LAD within 12 month was analyzed by Kaplan-Meier (KM) analysis. The predictive value of preoperative MHR, LAD, and their combination for post-RFA recurrence in PAF patients was analyzed.

RESULTS

MHR and LAD were independent risk factors for post-RFA recurrence in PAF patients. KM curve shift left in the high MHR and LAD groups versus the low MHR and LAD groups. MHR and LAD could help predict post-RFA recurrence in PAF patients, and the combined predictive value of MHR and LAD was greater than that of either factor alone.

CONCLUSION

MHR and LAD are independent risk factors for post-RFA PAF recurrence, and can help predict post-RFA recurrence in PAF patients, with their combined predictive value higher than that of each factor individually.

Semi-automatic software based detection of atrial fibrillation in acute ischaemic stroke and transient ischaemic attack

BACKGROUND AND PURPOSE

Paroxysmal atrial fibrillation (PAF) is often asymptomatic and increases the risk of ischaemic stroke. Detection of PAF is challenging but crucial because a change of treatment decreases the risk of ischaemic stroke. Post-stroke investigations recommend at least 24-h continuous cardiac rhythm monitoring. Extended monitoring detects more PAF but is limited by costs due to manual analysis. Interpretive software might be a reasonable screening tool. The aim was to validate the performance and utility of Pathfinder SL software compared to manual analysis.

METHODS

In all, 135 ischaemic stroke patients with no prior history of PAF or atrial fibrillation and who had done a 7-day continuous electrocardiogram monitoring (Holter) were included. Manual analysis was compared with Pathfinder SL software including a systematic control of registered events.

RESULTS

Seventeen (12.6%) patients were diagnosed with PAF (atrial fibrillation > 30 s). Pathfinder SL software including a systematic control of events registered 16 (94.1%) patients with PAF. Manually 15 (88.2%) patients were detected with PAF. Pathfinder SL had a negative predictive value of 99% and sensitivity of 94%.

CONCLUSIONS

Pathfinder SL software including a systematic evaluation of events is an acceptable alternative compared to manual analysis in PAF detection following ischaemic stroke. It is less time consuming and therefore a reliable, cheaper alternative compared to manual analysis.

Secondary Stroke Prevention: Improving Diagnosis and Management with Newer Technologies

Treatment of hypertension, diabetes, high cholesterol, smoking cessation, and healthy lifestyle have all contributed to the decline in the incidence of vascular disease over the last several decades. Patients who suffer an acute stroke are at a high risk for recurrence. Introduction of newer technologies and their wider use allows for better identification of patients in whom the risk of recurrence following an acute stroke may be very high. Traditionally, the major focus for diagnosis and management has focused on patient history, examination, imaging for carotid stenosis/occlusion, and detection of AF and paroxysmal AF (PAF) with 24-48 h cardiac monitoring. This review focuses on the usefulness of three newer investigative tools that are becoming widely available and lead to better prevention. Continuous ambulatory blood pressure measurements for 24 h or longer and 3D Doppler measures of the carotid arteries provide key useful information on the state of vascular health and enhance our ability to monitor the response to preventive therapies. Furthermore, the detection of PAF can be significantly improved with prolonged cardiac monitoring for 3 weeks or longer, enabling the initiation of appropriate prevention therapy. This review will focus on the potential impact and importance of these emerging technologies on the prevention of recurrent stroke in high-risk patients.

Associations with anticoagulation: a cross-sectional registry-based analysis of stroke survivors with atrial fibrillation

OBJECTIVE

To describe vitamin K antagonist (VKA) anticoagulation prescribing patterns in stroke survivors with atrial fibrillation (AF), with particular emphasis on sociodemographic associations with VKA prescription.

METHODS

We conducted a cross-sectional analysis of city-wide Glasgow primary care data held as part of the Local Enhanced Services (LES) for the year 2010. We collated clinical and sociodemographic data of community-dwelling ischaemic stroke survivors with AF, including risk factors; comorbidity; socioeconomic status and prescribing. We described stroke risk and bleeding risk using recommended stratification tools (CHA2DS2-VASC and HAS-BLED). Univariate and multivariate associations with anticoagulant prescription were described by ORs and corresponding 95% CI.

RESULTS

We identified 3429 community-dwelling, ischaemic stroke survivors with AF; median age 78 (IQR 72-84); 1699 (49%) male. Median CHA2DS2-VASC score was 5 (IQR 4-6). VKA was prescribed in 1165 (34%). On univariate analysis, higher CHA2DS2-VASC was associated with fewer VKA prescriptions (OR 0.90, 95% CI 0.45 to 0.95). On multivariate analysis, older age (OR 0.97, 95% CI 0.96 to 0.98) and higher deprivation scores (OR 0.59, 95% CI 0.57 to 0.76) were independently associated with non-prescription of VKA.

CONCLUSIONS

Anticoagulation was underused in this high-risk population, and those at highest risk were less likely to be treated. Strategies need to be developed to improve prescription of anticoagulation treatment.