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Callum K, Swinton P, Gorely T, Crabtree D, Leslie S. Physiological and psychological outcomes of high intensity interval training in patients with heart failure compared to moderate continuous training and usual care: A systematic review with meta analysis. Heart Lung 2024; 64:117-127. [PMID: 38159428 DOI: 10.1016/j.hrtlng.2023.12.002] [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: 08/07/2023] [Revised: 11/06/2023] [Accepted: 12/03/2023] [Indexed: 01/03/2024]
Abstract
BACKGROUND An important component of secondary prevention of CVD (including HF) is comprehensive cardiac rehab, including exercise. Novel, individualised approaches are needed to increase uptake and adherence to exercise programmes, one area offering potential is HIIT. HIIT has been shown to be both safe and effective for improving cardiovascular fitness in both coronary artery disease and HF patients. OBJECTIVES To provide a current and up to date evaluation of the physiological and psychological outcomes of HIIT in patients with HF compared to MCT and UC. Secondly to perform sub-group analyses comparing short and long HIIT protocols. METHODS A systematic review and meta-analysis of randomised controlled trials was undertaken. Medline, Embase, Scopus, CINAHL and SportDISCUS were searched up to July 2022. Trials were included if they carried out a HIIT intervention (defined at intensity ≥ 80% peak HR or ≥ 80% VO2peak) in HF patients (HFpEF or HFrEF) for at least 6 weeks. Comparator group was UC or MCT. RESULTS HIIT was shown to be superior to MCT and UC for improving VO2peak (HIIT mean improvement 3.1 mL.kg-1min-1). HITT was superior to MCT and UC for improving LVEF (HIIT mean improvement 5.7%). HIIT was superior to MCT and UC for improving HRQoL, using the MLHFQ (HIIT mean point change of -12.8). Subgroup analysis showed no difference between long and short HIIT. CONCLUSION HIIT improves VO2peak, LVEF and HRQoL in patients with HF, the improvements seen in VO2peak and LVEF are superior in HIIT compared to MCT and UC.
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Affiliation(s)
- Kara Callum
- NHS Highland, Raigmore Hospital, Old Perth Road, Inverness IV2 3UJ, United Kingdom; Department of Nursing and Midwifery, University of the Highlands and Islands, Inverness, United Kingdom.
| | - Paul Swinton
- School of Health Sciences, Robert Gordon University, Aberdeen, United Kingdom
| | - Trish Gorely
- Department of Nursing and Midwifery, University of the Highlands and Islands, Inverness, United Kingdom
| | - Daniel Crabtree
- Rowett Institute, University of Aberdeen, Aberdeen AB25 2ZD, United Kingdom
| | - Stephen Leslie
- Division of Biomedical Sciences, University of the Highlands and Islands, Inverness, United Kingdom; Cardiologist NHS Highland, Raigmore Hospital, Old Perth Road, Inverness IV2 3UJ, United Kingdom
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Muggeridge D, Callum K, Macpherson L, Howard N, Graune C, Megson I, Giangreco A, Gallacher S, Campbell L, Williams G, Macaden A, Leslie SJ. Clinical and health economic evaluation of a post-stroke arrhythmia monitoring service. Br J Cardiol 2022; 29:15. [PMID: 36212791 PMCID: PMC9534108 DOI: 10.5837/bjc.2022.015] [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] [Indexed: 06/16/2023]
Abstract
Atrial fibrillation (AF) is a major cause of recurrent stroke and transient ischaemic attack (TIA) in the UK. As many patients can have asymptomatic paroxysmal AF, prolonged arrhythmia monitoring is advised in selected patients following a stroke or TIA. This service evaluation assessed the clinical and potential health economic impact of prolonged arrhythmia monitoring post-stroke using R-TEST monitoring devices. This was a prospective, case-controlled, service evaluation in a single health board in the North of Scotland. Patients were included if they had a recent stroke or TIA, were in sinus rhythm, and did not have another indication for, or contraindication to, oral anticoagulation. A health economic model was developed to estimate the clinical and economic value delivered by the R-TEST monitoring. Approval to use anonymised patient data in this service evaluation was obtained. During the evaluation period, 100 consecutive patients were included. The average age was 70 ± 11 years, 46% were female. Stroke was the presenting complaint in 83% of patients with the other 17% having had a TIA. AF was detected in seven of 83 (8.4%) patients who had had a stroke and one of 17 (5.9%) patients with a TIA. Health economic modelling predicted that adoption of R-TEST monitoring has a high probability of demonstrating both clinical and economic benefits. In conclusion, developing a post-stroke arrhythmia monitoring service using R-TEST devices is feasible, effective at detecting AF, and represents a probable clinical and economic benefit.
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Affiliation(s)
- David Muggeridge
- Lecturer in Exercise Physiology Institute of Health Research and Innovation, University of the Highlands and Islands, Centre for Health Science, Old Perth Road, Inverness, IV2 3JH
| | - Kara Callum
- Cardiac Physiologist Institute of Health Research and Innovation, University of the Highlands and Islands, Centre for Health Science, Old Perth Road, Inverness, IV2 3JH
| | - Lynsey Macpherson
- Cardiac Physiologist NHS Highland, Raigmore Hospital, Old Perth Road, Inverness, IV2 3UJ
| | - Nick Howard
- Cardiac Physiologist NHS Highland, Raigmore Hospital, Old Perth Road, Inverness, IV2 3UJ
| | - Claudia Graune
- Cardiac Physiologist NHS Highland, Raigmore Hospital, Old Perth Road, Inverness, IV2 3UJ
| | - Ian Megson
- Head of Health Research and Innovation Institute of Health Research and Innovation, University of the Highlands and Islands, Centre for Health Science, Old Perth Road, Inverness, IV2 3JH
| | - Adam Giangreco
- Director of Health and Life Sciences Innovation Institute of Health Research and Innovation, University of the Highlands and Islands, Centre for Health Science, Old Perth Road, Inverness, IV2 3JH
| | - Susan Gallacher
- Stroke Audit Facilitator NHS Highland, Raigmore Hospital, Old Perth Road, Inverness, IV2 3UJ
| | - Linda Campbell
- Stroke Co-ordinator NHS Highland, Raigmore Hospital, Old Perth Road, Inverness, IV2 3UJ
| | - Gethin Williams
- Stroke Physician NHS Highland, Raigmore Hospital, Old Perth Road, Inverness, IV2 3UJ
| | - Ashish Macaden
- Rehabilitation Medicine and Stroke Physician NHS Highland, Raigmore Hospital, Old Perth Road, Inverness, IV2 3UJ
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Callum K, Graune C, Bowman E, Molden E, Leslie SJ. Remote monitoring of implantable defibrillators is associated with fewer inappropriate shocks and reduced time to medical assessment in a remote and rural area. World J Cardiol 2021; 13:46-54. [PMID: 33791078 PMCID: PMC7988594 DOI: 10.4330/wjc.v13.i3.46] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 06/12/2020] [Revised: 01/13/2021] [Accepted: 03/09/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Implantable cardioverter defibrillators (ICDs) and cardiac resynchronisation therapy with defibrillators (CRT-D) reduce mortality in certain cardiac patient populations. However, inappropriate shocks pose a problem, having both adverse physical and psychological effects on the patient. The advances in device technology now allow remote monitoring (RM) of devices to replace clinic follow up appointments. This allows real time data to be analysed and actioned and this may improve patient care.
AIM To determine if RM in patients with an ICD is associated with fewer inappropriate shocks and reduced time to medical assessment.
METHODS This was a single centre, retrospective observational study, involving 156 patients implanted with an ICD or CRT-D, followed up for 2 years post implant. Both appropriate and inappropriate shocks were recorded along with cause for inappropriate shocks and time to medical assessment.
RESULTS RM was associated with fewer inappropriate shocks (13.6% clinic vs 3.9% RM; P = 0.030) and a reduced time to medical assessment (15.1 ± 6.8 vs 1.0 ± 0.0 d; P < 0.001).
CONCLUSION RM in patients with an ICD is associated with improved patient outcomes.
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Affiliation(s)
- Kara Callum
- Department of Cardiology, NHS Highland, Inverness IV2 3UJ, United Kingdom
| | - Claudia Graune
- Department of Cardiology, NHS Highland, Inverness IV2 3UJ, United Kingdom
| | - Elizabeth Bowman
- Department of Cardiology, NHS Highland, Inverness IV2 3UJ, United Kingdom
| | - Edward Molden
- Department of Cardiology, NHS Highland, Inverness IV2 3UJ, United Kingdom
| | - Stephen J Leslie
- Department of Cardiology, NHS Highland, Inverness IV2 3UJ, United Kingdom
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