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Pubblicazioni recenti - cardiac rehabilitation
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Preoperative exercise training for adults undergoing elective major vascular surgery: A systematic review.
PLoS One2022 ;17(1):e0263090. doi: 10.1371/journal.pone.0263090.
Tew Garry A, Caisley Kim, Danjoux Gerard,
Abstract
Patients undergoing major vascular surgery may have an increased risk of postoperative complications due to poor 'fitness for surgery'. Prehabilitation aims to optimise physical fitness and risk factors before surgery to improve outcomes. The role of exercise-based prehabilitation in vascular surgery is currently unclear. Therefore, the aim of this systematic review was to assess the benefits and harms of preoperative exercise training in adults undergoing elective vascular surgery. We searched MEDLINE, Embase, CINAHL, and CENTRAL databases, trial registries, and forward and backward citations for studies published between January 2008 and April 2021. We included randomised trials that compared patients receiving exercise training with those receiving usual care or no training before vascular surgery. Outcomes included mortality, complications, and health-related quality of life (HRQOL). Three trials with 197 participants were included. All studies involved people undergoing abdominal aortic aneurysm (AAA) repair. Low-certainty evidence could not differentiate between rates of all-cause mortality. Moderate-certainty evidence indicated that postoperative cardiac and renal complications were less likely to occur in people who participated in preoperative exercise training compared with those who did not. Low-certainty evidence also indicated better postoperative HRQOL outcomes in people who undertook prehabilitation. There were no serious exercise-related adverse events. The evidence on preoperative exercise training for AAA patients is promising, but currently insufficiently robust for this intervention to be recommended in clinical guidelines. High-quality trials are needed to establish its clinical and cost-effectiveness. Research is also needed to determine the feasibility and effects of prehabilitation before lower-limb revascularisation. Trial registration: PROSPERO ID: CRD42021245933.
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Successful Coil Embolization Using Percutaneous Cardiopulmonary Support in a Patient with Refractory Out-of-hospital Cardiac Arrest Caused by Aneurysmal Subarachnoid Hemorrhage.
NMC Case Rep J2021 ;8(1):393-398. doi: 10.2176/nmccrj.cr.2020-0379.
Kano Hitoshi, Takigami Masayoshi, Matsui Toshihisa, Bando Keisuke, Endo Akio, Nagama Masaki,
Abstract
In recent years, extracorporeal cardiopulmonary resuscitation (ECPR) has been reported to be an effective alternative to conventional CPR for treating patients with reversible causes of cardiac arrest. Nevertheless, the definite indication for ECPR and also surgical interventions during ECPR treatment have not been established, especially in patients with out-of-hospital cardiac arrest (OHCA) caused by subarachnoid hemorrhage (SAH). We treated a comatose 50-year-old woman with refractory cardiac arrest due to aneurysmal SAH-induced takotsubo cardiomyopathy (TCM). The initial cardiac rhythm was ventricular fibrillation. This is the first case report on coil embolization being successfully performed on a patient undergoing ECPR and therapeutic hypothermia (TH) while the patient was still in cardiac arrest, which resulted in complete social rehabilitation. Moreover, the success of this treatment suggests that ECPR and endovascular therapy should be considered for highly selected patients when cardiopulmonary and neurological functions are potentially reversible even in the setting of SAH.
© 2021 The Japan Neurosurgical Society.
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Hypoxemia found after hospitalization with right hemiplegia due to cerebral infarction: platypnea-orthodeoxia syndrome in the older people.
J Cardiol Cases2022 Feb;25(2):72-75. doi: 10.1016/j.jccase.2021.06.015.
Tachibana Masatoshi, Kanemaru Akiko, Hatano Keiko, Murata Teppei, Ishikawa Joji, Harada Kazumasa,
Abstract
An 89-year-old woman was admitted to our hospital for subacute onset of right upper and lower limb weakness and was diagnosed with acute cerebral infarction. During rehabilitation, close observation revealed that her oxygen saturation decreased in the sitting position and improved in the recumbent position without any subjective symptoms of dyspnea. Transthoracic and transesophageal echocardiography and cardiac catheterization revealed a large patent foramen ovale with an atrial septal aneurysm with right-to-left shunting through the defect, and she was diagnosed with platypnea-orthodeoxia syndrome. Her right hemiplegia caused the trunk to collapse, so the patient slumped when in sitting position, and the trunk tilted to the right forward, resulting in an increased right-to-left shunt. Her peripheral capillary oxygen saturation improved in the upright sitting position supported by therapists. This case suggests that right hemiplegia may exacerbate the symptoms of platypnea-orthodeoxia syndrome. .
© 2021 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.
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Early experience with the Thopaz chest drainage system - is this a new era in the management of post-cardiotomy bleeding?
Kardiochir Torakochirurgia Pol2021 Dec;18(4):236-238. doi: 10.5114/kitp.2021.112191.
Pawelkowska Karolina, Bartus Stanislaw, Sobczynski Robert, Medrzycki Michal, Grudzien Grzegorz, Filip Grzegorz, Cierpikowski Bartosz, Bartus Krzysztof, Kapelak Boguslaw,
Abstract
Introduction:
Monitoring postoperative drainage is a key aspect of patient assessment in the early postoperative period. Accurate assessment of drainage allows rapid diagnosis of postoperative bleeding, preventing excessive hemoglobin drop and cardiac tamponade. However, traditional methods of mediastinal drainage appear to be inaccurate and measurement can often be subjective, delaying the procedure.
Aim:
To demonstrate our initial experience with a digital chest drainage system that can be used to closely monitor postoperative drainage.
Material and methods:
The Thopaz system allows manual regulation of negative pressure in the chest. The digital system analyzes the current and long-term values of the drainage, which facilitates therapeutic decisions. The advantage of the system is its mobility, without the need for built-in vacuums in the hospital wall. This allows early rehabilitation of the patient, which is crucial in the perioperative period. The Thopaz system has been used in 42 consecutive patients in all types of cardiac surgery procedures with good key results.
Results:
We did not observe any complications with the system and the learning curve of the staff was very fast, both for the physicians and the operating room nurses, intensive care nurses and postoperative nurses.
Conclusions:
The first experiences with the Topaz system were very positive. The system brings a lot of safety and comfort to the cardiac surgical care we provide. These conclusions are consistent with data published in randomized trials.
Copyright: © 2021 Polish Society of Cardiothoracic Surgeons (Polskie Towarzystwo KardioTorakochirurgów) and the editors of the Polish Journal of Cardio-Thoracic Surgery (Kardiochirurgia i Torakochirurgia Polska).
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Validation of the ACS-NSQIP Risk Calculator: A Machine-Learning Risk Tool for Predicting Complications and Mortality Following Adult Spinal Deformity Corrective Surgery.
Int J Spine Surg2021 Dec;15(6):1198-1204. doi: 10.14444/8153.
Pierce Katherine E, Kapadia Bhaveen H, Naessig Sara, Ahmad Waleed, Vira Shaleen, Paulino Carl, Gerling Michael, Passias Peter G,
Abstract
OBJECTIVE:
To calculate the risk for postoperative complications and mortality after corrective surgery of adult spinal deformity (ASD) patients using the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) surgical risk calculator (SRC).
METHODS:
Patients aged ?18 years undergoing corrective surgery for ASD were identified. Current procedural terminology (CPT) codes of 22800, 22802, 22804, 22808, 22801, 22812, 22818, 22819, 22843, 22844, 22846, 22847, 22842, and 22845 were assessed if the patient had an (ICD-9) scoliosis diagnosis (737.00-737.9). Calculated perioperative complication risk averages via the ACS-NSQIP surgical calculator were compared with observed complication rates. Outcomes assessed were as follows: serious complication, any complication, pneumonia, cardiac complication, surgical site infection, urinary tract infection, venous thromboembolism, renal failure, readmission, return to operating room, death, discharge to nursing or rehabilitation, sepsis, and total length of hospital stay. Predictive performance of the calculator was analyzed by computation of the Brier score. A Brier score is the sum of squared differences between the binary outcome and the predicted risk and ranges from 0 to a maximum Brier score = (mean observed outcome)*(1-[mean observed outcome]). Values closer to 0 are suggestive of better predictive performance. Length of stay (LOS) was assessed with a Bland-Altman plot, which plots the average of observed LOS on the axis and the difference between the observed and predicted LOS on the axis.
RESULTS:
A total of 9143 ASD patients (58.9 years, 56% females, 29.2 kg/m) were identified; 36.9% of procedures involved decompression and 100% involved fusion. The means for individual patient characteristics entered into the online risk calculator interface were as follows: functional status (independent: 94.9%, partially dependent: 4.4%, totally dependent: 0.70%), 1.6% emergent cases, wound class (clean: 94.7%, clean/contaminated: 0.8%, contaminated: 0.5%, dirty/infected: 1.4%), American Society of Anesthesiologists class (I: 2.7%, II: 40.7%, III: 52.1%, IV: 4.6%, V: 0%), 5.1% steroid use for chronic condition, 0.04% ascites within 30 days prior to surgery, 1.73% systemic sepsis within 48 hours of surgery, 0.40% ventilator dependent, 3.2% disseminated cancer, 15.6% diabetes mellitus, 52.8% use of hypertensive medications, 0.3% congestive heart failure , 3% dyspnea, 21.4% history of smoking within 1 year, 4.3% chronic obstructive pulmonary disease, 0.7% dialysis, and 0.1% acute renal failure. Predictive of any 30-day postoperative complications ranged from 2.8 to 18.5% across CPT codes, where the actual rate in the cohort was 11.4%, and demonstrated good predictive performance via Brier score (0.000002, maximum: 0.101). The predicted and observed percentages for each of the 13 outcomes were assessed and their associated Brier scores and Brier maximums were calculated. Mean difference between observed and predicted LOS was 2.375 days (95% CI 9.895-5.145).
CONCLUSIONS:
The ACS-NSQIP SRC predicts surgical risk in patients undergoing ASD corrective surgery. This tool can be used as a resource in preoperative optimization by deformity surgeons.
LEVEL OF EVIDENCE:
3.
This manuscript is generously published free of charge by ISASS, the International Society for the Advancement of Spine Surgery. Copyright © 2021 ISASS. To see more or order reprints or permissions, see http://ijssurgery.com.
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Effects of exercise rehabilitation in patients with long COVID-19.
Eur J Prev Cardiol2022 Jan;():. doi: zwac019.
Barbara Cristina, Clavario Piero, De Marzo Vincenzo, Lotti Roberta, Guglielmi Giulia, Porcile Annalisa, Russo Carmelo, Griffo Raffaele, Mäkikallio Timo, Hautala Arto Jorma, Porto Italo,
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Pre-operative neurodevelopmental assessment in young children undergoing cardiac surgery in central South Africa: feasibility and clinical value.
Cardiovasc J Afr2022 Jan;33():1-9. doi: 10.5830/CVJA-2021-057.
Smith Robyn, Ntsiea Veronica, Brown Stephen, Potterton Joanne,
Abstract
BACKGROUND:
Pre-operative neurodevelopmental assessment in children with congenital heart disease may assist in the early identification of children at risk for or presenting with developmental delays. This study determined the pre-operative neurodevelopmental status of young children undergoing cardiac surgery in central South Africa. Feasibility and clinical value of pre-operative assessment were also evaluated.
METHODS:
Children 30 months and younger, scheduled to undergo cardiac surgery, were recruited into this prospective observational analytical study. Neurodevelopmental status was assessed using the Bayley-III and neuromotor examination. Variables associated with developmental performance were determined using ANOVAs. Sociodemographic and medical information were collected using a self-developed questionnaire. Pre-operative neurodevelopmental assessment was completed for 40 children at a median age of 7.4 months, including 30 children without and 10 with Down syndrome. Mean cardiac disease severity was moderate. The inclusion rate for pre-operative developmental assessment was 68%, limited mainly by environmental barriers.
RESULTS:
Children with Down syndrome had significantly poorer motor (
CONCLUSION:
Pre-operative neurodevelopmental assessment may be of high importance in South Africa to identify children at developmental risk, facilitating early referral to rehabilitation therapies.
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An expert opinion of the Association of Cardiovascular Interventions and the Working Group on Cardiovascular Pharmacotherapy of the Polish Cardiac Society related to the place of prasugrel in the prevention of cardiovascular events in patients with acute coronary syndromes
Kardiol Pol2022 01;():. doi: 10.33963/KP.a2022.0006.
Barylski Marcin, Legutko Jacek, Lesiak Maciej, Bartu? Stanis?aw, Mamcarz Artur, Wo?akowska-Kap?on Beata, Grygier Marek, Wojakowski Wojciech, Witkowski Adam,
Abstract
Based on many randomized clinical trials, it can be concluded that dual antiplatelet therapy is one of the best-studied treatments in the field of cardiovascular medicine. For many years prasugrel and ticagrelor have been preferred inhibitors of the platelet P2Y12 receptor in patients with acute coronary syndromes. These drugs enable faster, stronger, and more consistent inhibition of platelets and lead to better clinical outcomes than clopidogrel. The following document is an expert group opinion summarizing the latest knowledge in the field of antiplatelet therapy in the prevention of cardiovascular events in patients with acute coronary syndromes, with a special focus on prasugrel.
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Association of improvement in functional capacity after rehabilitation with long-term survival in heart failure.
Int J Cardiol2022 Jan;():. doi: S0167-5273(22)00129-2.
Scrutinio Domenico, Guida Pietro, Passantino Andrea, Scalvini Simonetta, Bussotti Maurizio, Forni Giovanni, Tibollo Valentina, Vaninetti Raffaella, La Rovere Maria Teresa,
Abstract
BACKGROUND:
The prognostic value of change in six-minute walking distance (6MWD) after treatment to predict mortality in heart failure (HF) remains a controversial issue. We assessed the prognostic value of rehabilitation-induced improvement in 6MWD in predicting mortality in patients with HF.
METHODS:
We studied 2257 patients admitted to six inpatient rehabilitation facilities after a hospitalization for HF (N. 912) or because of worsening functional capacity and/or deteriorating clinical status (N. 1345). A six-minute walking test was performed at admission and discharge. The primary outcome was 3-year all-cause mortality after discharge from cardiac rehabilitation. We used multivariable Cox proportional hazard modeling to assess the association of increase in 6MWD with 3-year mortality, adjusting for established predictors of mortality.
RESULTS:
6MWD significantly increased by 61?m (p?.001) from admission to discharge and 969 patients (42.9%) achieved an increase in 6MWD >50?m. After full adjustment, an increase in 6MWD >50?m was associated with a 22% decreased risk for 3-year mortality (HR 0.78 [95% CI 0.68-0.91]; p?=?.002). When modeled as a continuous variable, improvement in 6MWD remained independently associated with decreased risk for 3-year mortality (HR per each 50?m increase: 0.92 [95% CI 0.88-0.96]).
CONCLUSIONS:
Rehabilitation-induced improvement in 6MWD was associated with a significantly reduced risk for 3-year mortality. Our data also suggest that an improvement in 6MWD of more than 50?m could represent a clinically meaningful endpoint of cardiac rehabilitation for patients with heart failure.
Copyright © 2022. Published by Elsevier B.V.
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Sarcoidosis - a multisystem disease.
Swiss Med Wkly2022 01;152():w30049. doi: 10.4414/smw.2022.w30049.
Franzen Daniel P, Brutsche Martin, Nilsson Jakob, Böni Christian, Daccord Cécile, Distler Oliver, Elsener Dieter, Funke-Chambour Manuela, Gruner Christiane, Hayward-Könnecke Helen, Hostettler Katrin E, Kündig Thomas, Ribi Camillo, Seebach Jörg D, Seeger Harald, Vrugt Bart, Kolios Antonios G A,
Abstract
Sarcoidosis is a systemic inflammatory disease, characterised by granuloma formation upon an unknown trigger in genetically predisposed individuals. The inflammation is characterised by an activation of both the innate immune system, with macrophages differentiating into epitheloid cells and dendritic cells, and the adaptive immune system, particularly T helper (Th) 1 and Th17 cells. Since all organs can be affected to varying extents, clinical presentation is often diverse. Most commonly, the lungs, lymph nodes, skin and eyes are involved, whereas cardiac, renal and neurological manifestations are less common but associated with higher morbidity. Depending on the clinical symptoms, a detailed evaluation including thorough clinical examination, imaging and laboratory tests should explore all possible organ involvements. In some patients, fatigue manifests as a para-sarcoidosis symptom impacting quality of life, even if sarcoidosis is in remission. Some acute syndromic presentations, such as Löfgren's syndrome, have a good prognosis and are commonly self-limiting. If possible, a topical treatment, for example for cutaneous sarcoidosis or bronchial involvement, should be applied. Treatment of severe cases with persisting disease activity necessitates long-term immunosuppressive drugs, with glucocorticoids as the first-line option. Steroid-sparing and second-line drugs include methotrexate, azathioprine, mycophenolate mofetil and immunomodulators such hydroxychloroquine, with the latter being first-line therapy in cutaneous sarcoidosis. Tumour necrosis factor-alpha inhibitors (particularly adalimumab and infliximab) are used as third-line agents but are administered earlier in cases of persistent disease activity, severe organ-involvement or intolerance to conventional drugs. Treatment decisions should be based on a multidisciplinary approach, depending on organ involvement and treatment tolerability. Para-sarcoidosis manifestations, particularly fatigue, should also be carefully addressed, where the patient could also be enrolled in multidimensional rehabilitation programmes. With various organ involvement and different phenotypes, larger studies including real-world data from registries are necessary to evaluate different sarcoidosis endotypes and preferential treatment pathways.
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Cardiorespiratory Responses During High-Intensity Interval Training Prescribed by Rating of Perceived Exertion in Patients After Myocardial Infarction Enrolled in Early Outpatient Cardiac Rehabilitation.
Front Cardiovasc Med2021 ;8():772815. doi: 10.3389/fcvm.2021.772815.
Dun Yaoshan, Hammer Shane M, Smith Joshua R, MacGillivray Mary C, Simmons Benjamin S, Squires Ray W, Liu Suixin, Olson Thomas P,
Abstract
We aimed to determine the cardiorespiratory responses during, and adaptations to, high-intensity interval training (HIIT) prescribed using ratings of perceived exertion (RPE) in patients after myocardial infarction (MI) during early outpatient cardiac rehabilitation (CR). We prospectively recruited 29 MI patients after percutaneous coronary intervention who began CR within 2 weeks after hospital discharge. Eleven patients (seven men; four women; age: 61 ± 11 yrs) who completed ?24 supervised HIIT sessions with metabolic gas exchange measured during HIIT once weekly for 8 weeks and performed pre- and post- CR cardiopulmonary exercise tests were included in the study. Each HIIT session consisted of 5-8 high-intensity intervals [HIIs, 1-min RPE 14-17 (Borg 6-20 scale)] and low-intensity intervals (LIIs, 4-min RPE 0.05). increased by an average of 9% from pre-CR to post-CR. No adverse events occurred. Our results demonstrate that HIIT can be effectively prescribed using RPE in MI patients during early outpatient CR. Participation in RPE-prescribed HIIT increases exercise workload and during exercise training without increased perception of effort or excessive increases in heart rate or blood pressure.
Copyright © 2022 Dun, Hammer, Smith, MacGillivray, Simmons, Squires, Liu and Olson.
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Exercise Intolerance, Benefits, and Prescription for People Living With a Fontan Circulation: The Fontan Fitness Intervention Trial (F-FIT)-Rationale and Design.
Front Pediatr2021 ;9():799125. doi: 10.3389/fped.2021.799125.
Tran Derek L, Gibson Hannah, Maiorana Andrew J, Verrall Charlotte E, Baker David W, Clode Melanie, Lubans David R, Zannino Diana, Bullock Andrew, Ferrie Suzie, Briody Julie, Simm Peter, Wijesekera Vishva, D'Almeida Michelle, Gosbell Sally E, Davis Glen M, Weintraub Robert, Keech Anthony C, Puranik Rajesh, Ugander Martin, Justo Robert, Zentner Dominica, Majumdar Avik, Grigg Leeanne, Coombes Jeff S, d'Udekem Yves, Morris Norman R, Ayer Julian, Celermajer David S, Cordina Rachael,
Abstract
Despite developments in surgical techniques and medical care, people with a Fontan circulation still experience long-term complications; non-invasive therapies to optimize the circulation have not been established. Exercise intolerance affects the majority of the population and is associated with worse prognosis. Historically, people living with a Fontan circulation were advised to avoid physical activity, but a small number of heterogenous, predominantly uncontrolled studies have shown that exercise training is safe-and for unique reasons, may even be of heightened importance in the setting of Fontan physiology. The mechanisms underlying improvements in aerobic exercise capacity and the effects of exercise training on circulatory and end-organ function remain incompletely understood. Furthermore, the optimal methods of exercise prescription are poorly characterized. This highlights the need for large, well-designed, multi-center, randomized, controlled trials. The Fontan Fitness Intervention Trial (F-FIT)-a phase III clinical trial-aims to optimize exercise prescription and delivery in people with a Fontan circulation. In this multi-center, randomized, controlled study, eligible Fontan participants will be randomized to either a 4-month supervised aerobic and resistance exercise training program of moderate-to-vigorous intensity followed by an 8-month maintenance phase; or usual care (control group). Adolescent and adult (?16 years) Fontan participants will be randomized to either traditional face-to-face exercise training, telehealth exercise training, or usual care in a three-arm trial with an allocation of 2:2:1 (traditional:telehealth:control). Children (
Copyright © 2022 Tran, Gibson, Maiorana, Verrall, Baker, Clode, Lubans, Zannino, Bullock, Ferrie, Briody, Simm, Wijesekera, D'Almeida, Gosbell, Davis, Weintraub, Keech, Puranik, Ugander, Justo, Zentner, Majumdar, Grigg, Coombes, d'Udekem, Morris, Ayer, Celermajer and Cordina.
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Lessons from the short- and mid-term outcome of medical rehabilitation in adults with congenital heart disease.
Cardiovasc Diagn Ther2021 Dec;11(6):1416-1431. doi: 10.21037/cdt-20-727.
Freilinger Sebastian, Andric Dario, Andonian Caroline, Beckmann Jürgen, Bongarth Christa, Einwang Hans Peter, Ewert Peter, Hofbeck Michael, Kaemmerer Ann-Sophie, Nagdyman Nicole, Oberhoffer Renate, von Kodolitsch Yskert, Kaemmerer Harald, Neidenbach Rhoia,
Abstract
Background:
The number of adults with congenital heart disease (ACHD) is steadily increasing. Over their life-time, many of the affected patients require medical rehabilitation after interventional or surgical treatment of residua, sequels or complications of their congenital heart defect (CHD). However, up to now only scarce data exist about indication, performance and outcomes of cardiac rehabilitation in ACHD.
Methods:
The course and outcome of rehabilitation after previous interventional or surgical treatment in ACHD was analyzed in a retrospective cohort study.
Results:
Two hundred and five ACHD {54% female; mean age 34±12 [16-68] years} with mild (23.9%), moderate (35.1%) or severe CHD (41.0%), of whom 32% had complex CHD, 21% right-ventricular out?ow tract obstructions, 20% pre-tricuspid shunts, 18% left heart or aortic anomalies, 9% post-tricuspid shunts and 2% other congenital cardiac anomalies were included into analysis. The main indications for rehabilitation were a preceding surgical (92%) or interventional (3%) treatment of the underlying CHD immediately before rehabilitation. During rehabilitation, no severe complications occurred. The number of patients in function class I/II increased from 189 to 200 and decreased in class III/IV from 16 to 5. Cardiac medication could be reduced or stopped after rehabilitation in 194 patients, with the exception of ACE-inhibitors. There was an improvement in cardiovascular risk factors. While before medical treatment 77% (n=157) patients were capable of working, the number increased to 82% [168] at the end of rehabilitation. Throughout a follow-up 9.3% (n=19) of patients needed further cardiac interventions.
Conclusions:
The current study provided for the first time comprehensive data on the course of rehabilitation in a large cohort of ACHD after surgical or interventional treatment. The overall outcome of ACHD after rehabilitation was uneventful and favorable. Further research is required to assess the clinical long-term outcome, the impact of rehabilitation on the quality of life, disease coping and employment. The results of this study can serve as a benchmark for the development of speci?c rehabilitation programs in ACHD.
2021 Cardiovascular Diagnosis and Therapy. All rights reserved.
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Current role and future perspectives of cardiac rehabilitation in coronary heart disease.
World J Cardiol2021 Dec;13(12):695-709. doi: 10.4330/wjc.v13.i12.695.
Vilela Eduardo M, Ladeiras-Lopes Ricardo, Joao Ana, Braga Joana, Torres Susana, Viamonte Sofia, Ribeiro José, Teixeira Madalena, Nunes José P, Fontes-Carvalho Ricardo,
Abstract
Ischaemic heart disease (IHD) is a major cause of morbidity and mortality worldwide. While there have been major advances in this field, these patients are still a higher risk subgroup. As such, strategies to mitigate risk and tailor secondary prevention measures are of the utmost relevance. Cardiac rehabilitation (CR), encompassing several domains including exercise training, cardiovascular risk factor optimization, nutritional and psychological assessments, as well as other ancillary interventions has shown to be one of the pillars in the contemporary management of patients with IHD. Indeed, CR is associated with several benefits in this population, ranging from functional capacity to improvements in outcomes. Whilst this, there are still several issues concerning the optimal application of CR which are still not fully ascertained, such as lack of referral and completion, as well as questions related to programme design (particularly among patients with multiple comorbidities). In this review, we aim at presenting a pragmatic overview on the current role of CR in the management of individuals with IHD, while also discussing some of the caveats in the current data, as well as future concepts which could help improve the uptake and personalization of this pivotal time-tested intervention.
©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
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Reduced Reflex Autonomic Responses Following Intradetrusor OnabotulinumtoxinA Injections: A Pre-/Post-study in Individuals With Cervical and Upper Thoracic Spinal Cord Injury.
Front Physiol2021 ;12():796277. doi: 10.3389/fphys.2021.796277.
Dorey Tristan W, Walter Matthias, Krassioukov Andrei V,
Abstract
Urodynamic studies (UDS) can provoke autonomic dysreflexia (AD) in individuals with spinal cord injury (SCI) at and above the sixth thoracic spinal segment potentially leading to profound vagally mediated heart rate (HR) reductions. In this study, we test the hypothesis that intradetrusor onabotulinumtoxinA injections will improve HR and its variability (HRV) responses to UDS in individuals with cervical and thoracic SCI. A total of 19 participants with chronic SCI (5 women, mean age 42.5?±?7.9 years) with confirmed neurogenic detrusor overactivity underwent UDS before (i.e., baseline) and 1?month after intradetrusor onabotulinumtoxinA (200?U) injections (post-treatment). Continuous electrocardiography and blood pressure (BP) recordings were used to assess RR-interval, time, and frequency domain metrics of HRV (a surrogate marker of autonomic nervous system activity), and AD pre- and post-treatment. UDS pre-treatment resulted in increased RR-interval as well as time and frequency domain metrics of HRV. Vagally mediated increases in high-frequency (HF) power during UDS were larger in participants with cervical compared to upper thoracic SCI. Post-treatment, UDS had no effect on RR-interval and significantly reduced instances of bradycardia. Furthermore, intradetrusor onabotulinumtoxinA injections significantly reduced time domain metrics of HRV and HF power responses to UDS across all participants. Changes in HRV during UDS could be a potential indicator of improved autonomic cardiovascular function following interventions such as intradetrusor onabotulinumtoxinA injections.
Copyright © 2021 Dorey, Walter and Krassioukov.
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The Impact of Cardiac Rehabilitation on Activities of Daily Life in Elderly Patients With Heart Failure.
Front Physiol2021 ;12():785501. doi: 10.3389/fphys.2021.785501.
Paneroni Mara, Scalvini Simonetta, Corrà Ugo, Lovagnini Marta, Maestri Roberto, Mazza Antonio, Raimondo Rosa, Agostoni Piergiuseppe, La Rovere Maria Teresa,
Abstract
In elderly chronic heart failure (HF) patients, activities of daily living (ADLs) require the use of a high proportion of patients' peak aerobic capacity, heart rate, and ventilation. To assess the effects of short-term comprehensive cardiac rehabilitation (CR) on the metabolic requirement of ADLs in elderly patients with chronic HF. The study population comprised 99 elderly chronic HF patients (mean age 72?±?5?years, 80% male, 61% ejection fraction
Copyright © 2022 Paneroni, Scalvini, Corrà, Lovagnini, Maestri, Mazza, Raimondo, Agostoni and La Rovere.
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Feasibility of home-based cardiac rehabilitation in frail older patients: a clinical perspective.
Physiother Theory Pract2022 Jan;():1-16. doi: 10.1080/09593985.2022.2025549.
Terbraak Michel, Verweij Lotte, Jepma Patricia, Buurman Bianca, Jørstad Harald, Scholte Op Reimer Wilma, van der Schaaf Marike,
Abstract
(A) BACKGROUND:
Home-based cardiac rehabilitation (CR) is an attractive alternative for frail older patients who are unable to participate in hospital-based CR. Yet, the feasibility of home-based CR provided by primary care physiotherapists (PTs) to these patients remains uncertain.
(B) OBJECTIVE:
To investigate physiotherapists' (PTs) clinical experience with a guideline-centered, home-based CR protocol for frail older patients.
(C) METHODS:
A qualitative study examined the home-based CR protocol of a randomized controlled trial. Observations and interviews of the CR-trained primary care PTs providing home-based CR were conducted until data saturation. Two researchers separately coded the findings according to the theoretical framework of Gurses.
(D) RESULTS:
The enrolled PTs (n = 8) had a median age of 45 years (IQR 27-57), and a median work experience of 20 years (IQR 5-33). Three principal themes were identified that influence protocol-adherence by PTs and the feasibility of protocol-implementation: 1) feasibility of exercise testing and the exercise program; 2) patients' motivation and PTs' motivational techniques; and 3) interdisciplinary collaboration with other healthcare providers in monitoring patients' risks.
(E) CONCLUSION:
Home-based CR for frail patients seems feasible for PTs. Recommendations on the optimal intensity, use of home-based exercise tests and measurement tools, and interventions to optimize self-regulation are needed to facilitate home-based CR.
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Direct costs of adhering to selected Duchenne muscular dystrophy care considerations: estimates from a Midwestern state.
Muscle Nerve2022 Jan;():. doi: 10.1002/mus.27505.
Conway Kristin M, Grosse Scott D, Ouyang Lijing, Street Natalie, Romitti Paul A,
Abstract
INTRODUCTION/AIMS:
The multidisciplinary Duchenne muscular dystrophy (DMD) Care Considerations were developed to standardize care and improve outcomes. We provide cumulative cost estimates for selected key preventive (i.e., excluding new molecular therapies and acute care) elements of the care considerations in eight domains (neuromuscular, rehabilitation, respiratory, cardiac, orthopedic, gastrointestinal, endocrine, psychosocial management) independent of completeness of uptake or provision of non-preventive care.
METHODS:
We used de-identified insurance claims data from a large Midwestern commercial health insurer during 2018. We used Current Procedural Terminology and National Drug codes to extract unit costs for clinical encounters representing key preventive elements of the DMD Care Considerations. We projected per-patient cumulative costs from ages 5 to 25?years for these elements by multiplying a schedule of recommended frequencies of preventive services by unit costs in 2018 US dollars.
RESULTS:
Assuming a diagnosis at age 5?years, independent ambulation until age 11, and survival until age 25, we estimated 670 billable clinical events. The 20-year per-patient cumulative cost was $174,701 with prednisone ($2.3 million with deflazacort) and an expected total of $12,643 ($29,194) for out-of-pocket expenses associated with those events and medications.
DISCUSSION:
Standardized monitoring of disease progression and treatments may reduce overall costs of illness. Costs associated with these services would be needed to quantify potential savings. Our approach demonstrates a method to estimate costs associated with implementation of preventive care schedules.
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Clinical and Economic Burden of Out-of-Hospital Cardiac Arrest in US Commercial Insurance Population (2014 to 2019).
Am J Cardiol2022 Jan;():. doi: S0002-9149(21)01272-8.
Chirikov Viktor V, Corman Shelby, Qiao Yao, Huang Xingyue,
Abstract
Little is known about the economic burden incurred by out-of-hospital cardiac arrest (OHCA) in the US commercial insurance setting. We used IBM MarketScan Commercial Claims and Encounters Database (January 2014 to March 2019) to identify patients hospitalized with OHCA based on the International Classification of Diseases codes. Patients who survived the initial OHCA episode were stratified by prognosis based on discharge setting and classified into mild (discharged home), moderate (skilled nursing facility), severe (inpatient rehabilitation or long-term hospital), and very severe (hospice) prognosis groups, respectively. Patients were followed up for 12 months after discharge for health care resource utilization and medical costs, which were inflated to year 2020. Overall, 23,512 patients with OHCA hospitalization were identified, of whom 14,667 were
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Combined Role of Troponin and Natriuretic Peptides Measurements in Patients With Covid-19 (from the Cardio-COVID-Italy Multicenter Study).
Am J Cardiol2022 Jan;():. doi: S0002-9149(21)01204-2.
Iorio Annamaria, Lombardi Carlo Mario, Specchia Claudia, Merlo Marco, Nuzzi Vincenzo, Ferraro Ilenia, Peveri Giulia, Oriecuia Chiara, Pozzi Andrea, Inciardi Riccardo M, Carubelli Valentina, Bellasi Antonio, Canale Claudia, Camporotondo Rita, Catagnano Francesco, Vecchia Laura Dalla, Giovinazzo Stefano, Maccagni Gloria, Mapelli Massimo, Margonato Davide, Monzo Luca, Provenzale Giovanni, Sarullo Filippo, Tomasoni Daniela, Ameri Pietro, Gnecchi Massimiliano, Leonardi Sergio, Agostoni Piergiuseppe, Carugo Stefano, Danzi Gian Battista, Guazzi Marco, La Rovere Maria Teresa, Mortara Andrea, Piepoli Massimo, Porto Italo, Volterrani Maurizio, Sinagra Gianfranco, Senni Michele, Metra Marco,
Abstract
Data concerning the combined prognostic role of natriuretic peptide (NP) and troponin in patients with COVID-19 are lacking. The aim of the study is to evaluate the combined prognostic value of NPs and troponin in hospitalized COVID-19 patients. From March 1, 2020 to April 9, 2020, consecutive patients with COVID-19 and available data on cardiac biomarkers at admission were recruited. Patients admitted for acute coronary syndrome were excluded. Troponin levels were defined as elevated when greater than the 99 percentile of normal values. NPs were considered elevated if above the limit for ruling in acute heart failure (HF). A total of 341 patients were included in this study, mean age 68 ± 13 years, 72% were men. During a median follow-up period of 14 days, 81 patients (24%) died. In the Cox regression analysis, patients with elevated both NPs and troponin levels had higher risk of death compared with those with normal levels of both (hazard ratio 2.94; 95% confidence interval 1.31 to 6.64; p = 0.009), and this remained significant after adjustment for age, gender, oxygen saturation, HF history, and chronic kidney disease. Interestingly, NPs provided risk stratification also in patients with normal troponin values (hazard ratio 2.86; 95% confidence interval 1.21 to 6.72; p = 0.016 with high NPs levels). These data show the combined prognostic role of troponin and NPs in COVID-19 patients. NPs value may be helpful in identifying patients with a worse prognosis among those with normal troponin values. Further, NPs' cut-point used for diagnosis of acute HF has a predictive role in patients with COVID-19.
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