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Pubblicazioni recenti - cardiac rehabilitation
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The effect of cardiac rehabilitation at 4 weeks postoperatively on quality of life in patients treated with totally thoracoscopic ablation.
J Exerc Rehabil2019 Aug;15(4):610-615. doi: 10.12965/jer.1938340.170.
Seo Yong-Gon, Sung Jidong, Shin Mal-Soon, Park Yun-Jin, Min Kyoung-Bin, Kang Gyu-Min, Lee Jong-Min, Kim Myung-Ki,
Abstract
There is a lack of evidence on the effect of exercise-based cardiac rehabilitation (EBCR) in patients treated with total thoracoscopic ablation (TTA) for atrial fibrillation (AF). Our study investigated the efficacy and safety of postoperative exercise intervention in patients recovering from TTA. Twenty-four patients participated in the study, and were divided into the two groups, exercise group (EG) (n=12) and control group (n= 12). Patients in EG performed the exercise intervention including the aerobic and resistance exercise program twice a week for 8 weeks, which was used as a hospital-based cardiac rehabilitation for the out-patient. A cardiopulmonary exercise test was administered to evaluate aerobic exercise capacity, and qualitative aspect of patient's life was assessed using the Short Form 36 questionnaires to compare pre and postoperative wellness of patient's life. Although there was an increase of VO (peak oxygen uptake) after exercise intervention, no significant improvement was found (=0.055). Two of 4 physical health scores (role-physical, =0.013 and general health, =0.05) and three of four mental health scores (vitality, =0.027, social function, =0.016, and mental health, =0.003) were significantly improved after 8 weeks of EBCR. Each summarized scale in the physical (=0.022) and mental (= 0.004) survey section was also significantly improved in postoperative assessment compared to the preoperative one. In this context, we concluded that EBCR initiated at the time point of 4th week after TTA operation can guarantee the secure postoperative physical activity, and the 8 weeks of EBCR can effectively improve the quality of life in AF Patients.
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The association of cardiovascular reactivity during the Trier Social Stress Test with quality of life in coronary artery disease patients.
J Psychosom Res2019 Sep;126():109824. doi: S0022-3999(19)30175-8.
Gecaite Julija, Burkauskas Julius, Bunevicius Adomas, Brozaitiene Julija, Kazukauskiene Nijole, Mickuviene Narseta,
Abstract
OBJECTIVE:
Knowledge of objective psychophysiological stress parameters and its relationship to health-related quality of life (HRQoL) is limited in patients with coronary artery disease (CAD). The aim was to investigate the association of cardiovascular reaction to psychosocial stress with HRQoL in patients with CAD.
METHODS:
One-hundred and thirty-six patients (84.6% men, age 52?±?8) within 2-3?weeks after acute coronary syndromes (ACS) during cardiac rehabilitation were recruited in this cross-sectional study. Patients were evaluated for HRQoL (SF-36 questionnaire), symptoms of anxiety and depression (Hospital Anxiety and Depression scale) and Type D personality (DS14 scale). Trier Social Stress Test (TSST) was employed to evaluate cardiovascular reactivity (systolic and diastolic blood pressure [BP], and heart rate [HR]) to psychosocial stress. Multiple linear regression analyses were performed to test for the associations between cardiovascular reactivity and HRQoL, while controlling for possible confounders.
RESULTS:
After controlling for baseline levels of HR, gender, age, NYHA functional class, AH, Type D personality, symptoms of anxiety and depression, use of beta-blockers, and history of smoking, the SF-36 Social functioning scale (??=?-0.182; p?=?.03) and SF-36 Vitality scale (??=?-0.203; p?=?.03) was associated with prolonged HR recovery following stress evoking tasks. No associations were found between HRQoL and BP measures during the TSST.
CONCLUSION:
In CAD patients who have experienced ACS, HRQoL was associated with prolonged HR recovery after mental stress, even after controlling for potential confounder. Future studies should investigate the possible role of mediating factors involved in the mechanisms relating cardiovascular stress response and HRQoL.
Copyright © 2019. Published by Elsevier Inc.
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Barriers to Engagement in Chronic Heart Failure Rehabilitation: An Australian Survey.
Heart Lung Circ2019 Aug;():. doi: S1443-9506(19)31375-7.
Palmer Katie, Bowles Kelly-Ann, Lane Rebecca, Morphet Julia,
Abstract
BACKGROUND:
While exercise has been shown to improve quality of life and physical function and reduce hospital admission rates in people with chronic heart failure (CHF), engagement is poor in condition specific rehabilitation programs. This project aims to identify barriers to engagement in rehabilitation, strategies to address these, and comprehensively detail CHF rehabilitation practise in Australia.
METHODS:
An online survey was emailed to all cardiac and chronic heart failure rehabilitation programs in Australia utilising a publicly available database.
RESULTS:
The survey was completed by 165 respondents: Australian Capital Territory (ACT)?=?4, New South Wales (NSW)?=?49, Northern Territory (NT)?=?2, Queensland (Qld)?=?23, South Australia (SA)?=?12, Tasmania (Tas)?=?2, Victoria (Vic)?=?37, Western Australia (WA)?=?12, including metropolitan (37%), regional (47%) and remote (9%) locations. Common barriers were themed into four areas: poor condition-specific health literacy, lack of medical professional support, interrupted health care systems, and personal and external deterrents. Strategies to improve engagement and attendance focussed mostly on the patient, with few strategies aimed at improving patient and health professional knowledge and referral processes. Programs generally appeared to follow current Australian Heart Foundation recommendations for CHF rehabilitation.
CONCLUSIONS:
This survey identifies common barriers that need to be addressed to improve engagement and attendance levels in CHF rehabilitation programs. While patient barriers are already being addressed, strategic planning needs to occur to address poor health literacy including for medical and health professionals, improved flow through the health care system and improving the flexibility of program delivery. Adaptation of home-based and tele-rehabilitation can help with this, while education and advertisement to patients and potential referrers needs to start early in the disease journey.
Copyright © 2019 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights reserved.
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Stroke care in 1960 and now-the case of René Maugras.
Rev Neurol (Paris)2019 Sep;():. doi: S0035-3787(19)30612-5.
André C,
Abstract
BACKGROUND/OBJECTIVE:
Georges Simenon accurately describes, in a novel called Les Anneaux de Bicêtre, the clinical picture and course, and the hospital procedures and treatment of a patient with a large left hemispheric stroke, presumably ischemic.
METHODS:
I here summarize these features and use them as a basis to discuss the marked changes in stroke evaluation and care in the last 60 years.
RESULTS/CASE REPORT:
A 54-year old Newspaper director was admitted shortly after an acute stroke leading to temporary loss of consciousness, to motor aphasia and right hemiplegia and hypoesthesia. Risk factors included hypertension, a sedentary life, smoking, and a previous episode of cardiac arrhythmia possibly related to congenital heart disease. Evaluation included electroencephalography, cerebral arteriography and cerebrospinal fluid analysis. The acute treatment involved prolonged bed rest in a private room, prophylactic antibiotics, and oral anticoagulation. Smoking was allowed. Prolonged in-hospital rehabilitation followed initial passive physical therapy provided by nurses. After many months, the patient was released with persistent motor problems and a marked psychological change.
CONCLUSION:
The entire field of acute stroke care has been revolutionized in the last 60 years. Big data management, telemedicine, software, new brain and vascular imaging techniques, biomarkers, robotics etc., are currently in development and again should lead to new and surprising changes during the next decades.
Copyright © 2019 Elsevier Masson SAS. All rights reserved.
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Detection of Na1.5 Conformational Change in Mammalian Cells Using the Noncanonical Amino Acid ANAP.
Biophys J2019 Aug;():. doi: S0006-3495(19)30745-3.
Shandell Mia A, Quejada Jose R, Yazawa Masayuki, Cornish Virginia W, Kass Robert S,
Abstract
Na1.5 inactivation is necessary for healthy conduction of the cardiac action potential. Genetic mutations of Na1.5 perturb inactivation and cause potentially fatal arrhythmias associated with long QT syndrome type 3. The exact structural dynamics of the inactivation complex is unknown. To sense inactivation gate conformational change in live mammalian cells, we incorporated the solvatochromic fluorescent noncanonical amino acid 3-((6-acetylnaphthalen-2-yl)amino)-2-aminopropanoic acid (ANAP) into single sites in the Na1.5 inactivation gate. ANAP was incorporated in full-length and C-terminally truncated Na1.5 channels using mammalian cell synthetase-tRNA technology. ANAP-incorporated channels were expressed in mammalian cells, and they exhibited pathophysiological function. A spectral imaging potassium depolarization assay was designed to detect ANAP emission shifts associated with Na1.5 conformational change. Site-specific intracellular ANAP incorporation affords live-cell imaging and detection of Na1.5 inactivation gate conformational change in mammalian cells.
Copyright © 2019 Biophysical Society. Published by Elsevier Inc. All rights reserved.
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Cardiovascular autonomic individual profile of relapsing-remitting multiple sclerosis patients and risk of extending cardiac monitoring after first dose fingolimod.
J Neurol Sci2019 Aug;405():116423. doi: S0022-510X(19)30355-7.
Vanoli Emilio, Montano Nicola, De Angelis Giuseppe, Badilini Fabio, Mirabella Massimiliano, Bonavita Simona, Patti Francesco, Bianco Assunta, Sparaco Maddalena, Chisari Clara, Laroni Alice, Frigerio Francesca, Bartezaghi Marta, Rossi Silvia, Turrini Renato, Mancardi Gianluigi,
Abstract
Fingolimod exerts its therapeutic effect in multiple sclerosis by modulating sphingosine-1P receptors which are expressed in the heart mediating fingolimod first dose effects. Understanding potential interactions of baseline characteristics and autonomic profile with fingolimod first dose effects may add novel safety information and help explain cases requiring extension of the 6-hour ECG monitoring period. We aimed at characterizing the patient population treated with the first dose of fingolimod in clinical practice in an observational, multicenter, prospective 6-hours (up to 24) study. ECG was recorded for 15?min before first fingolimod administration and for 6?h after. Heart rate (HR) and HR variability in the frequency domain were derived from ECG traces. Out of the 625 enrolled patients, 580 (92.8%) were discharged at the sixth hour after fingolimod first dose; 45 (7.2%) required monitoring extension. Data confirm the well characterized cardiovascular fingolimod profile upon treatment initiation. Ten (1.6%) patients showed an atrioventricular block, all asymptomatic and self-resolving. Normalized spectral power in the High Frequency band (marking vagal modulation) and previous annualized relapse rate were independently correlated with the probability of undergoing extended monitoring. Our results could provide useful information for the stratification and individualized monitoring of MS patients prescribed with fingolimod.
Copyright © 2019. Published by Elsevier B.V.
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Risk score for nonhome discharge after lower extremity bypass.
J Vasc Surg2019 Sep;():. doi: S0741-5214(19)31801-4.
Iannuzzi James C, Boitano Laura T, Cooper Michol A, Watkins Michael T, Eagleton Matthew J, Clouse W Darrin, Conte Michael S, Conrad Mark F,
Abstract
OBJECTIVE:
Patients undergoing lower extremity bypass (LEB) for peripheral artery disease require intensive health care resource utilization including rehabilitation and skilled nursing facilities. However, few studies have evaluated factors that lead to nonhome discharge (NHD) in this population of patients. This study sought to predict NHD by preoperative risk factors in patients undergoing LEB for peripheral artery disease using a novel risk score.
METHODS:
The Vascular Study Group of New England database was queried for elective LEB for peripheral artery disease including claudication and critical limb ischemia from 2003 to 2017. Patients were excluded if the procedure was not elective, if they were not admitted from home, if they were bedridden, or if they died during the index admission. Only preoperative factors were considered in the analysis. The primary end point was NHD including rehabilitation and skilled nursing facilities. Data were split two-thirds for model derivation and one-third for validation. In the derivation cohort, bivariate analysis assessed the association of preoperative factors with NHD. A parsimonious manual stepwise binary logistic regression for NHD aimed at maximizing the C statistic while maintaining model simplicity was performed. A risk score was developed using the ? coefficients and applied to the validation data set. The risk score performance was assessed using a C statistic and Hosmer-Lemeshow test for model fit.
RESULTS:
There were 10,145 cases included with an overall NHD rate of 26.4% (n = 2676). Mean age was 66 years (range, 41-90 years). NHD patients were older (72 years vs 64 years; P < .01) and more frequently male (57.2% vs 42.8%; P < .01) and nonwhite (16.1% vs 9.9%; P < .01); they more frequently had tissue loss (54.2% vs 23.0%; P < .01), anemia (16.0% vs 5.3%; P < .01), severe cardiac comorbidity (21.8% vs 10.5%; P < .01), and insulin-dependent diabetes (33.3% vs 18.2%; P < .01). On multivariable analysis, factors associated with NHD included age, sex, nonwhite race, tissue loss, cardiac comorbidity, partial ambulatory deficit, and insulin-dependent diabetes. The C statistic was 0.78 in the derivation group and 0.79 in the validation group, with Hosmer-Lemeshow P > .999. The risk score ranged from 0 to 18, with a mean score of 4 (standard deviation ±3.5). The risk score was divided into low risk (0-4 points; n = 5272 [52%]; NHD = 10.1%]), moderate risk (5-9 points; n = 3663 [36.7%]; NHD = 36.7%), and high risk (?10 points; n = 1210 [11.9%]; NHD = 66.1%).
CONCLUSIONS:
This novel risk score was highly predictive for NHD after LEB for peripheral artery disease using only preoperative comorbidities. High-risk patients account for 12% of LEB but nearly a third of all patients requiring NHD. This risk score can be used preoperatively to determine high-risk patients for NHD, which may help improve preoperative counseling and hospital efficiency by allocating resources appropriately.
Copyright © 2019 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.
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LVAD speed increase during exercise, which patients would benefit the most? A simulation study.
Artif Organs2019 Sep;():. doi: 10.1111/aor.13569.
Gross C, Moscato F, Schlöglhofer T, Maw M, Meyns B, Marko C, Wiedemann D, Zimpfer D, Schima H, Fresiello L,
Abstract
Patients supported with an LVAD have impaired cardiovascular adaptations during exercise, resulting in reduced total cardiac output and exercise intolerance. The aim of this study is to report associations among these impaired cardiovascular parameters and exercise hemodynamics, and to identify in which conditions an LVAD speed increase can provide substantial benefits to exercise. A cardiorespiratory simulator was used to reproduce the average hemodynamics of LVAD patients at exercise. Then, a sensitivity study was conducted where cardiovascular parameters were changed individually ±20% of their baseline value at exercise (heartrate, left/right ventricular contractility, total peripheral resistance and valve pathologies). Simulations were performed at a baseline LVAD speed of 2700 rpm and repeated at 3500 rpm to evaluate the benefits of a higher LVAD support on hemodynamics. Total cardiac output (TCO) was mostly impaired by a poor left ventricular contractility or vasodilation at exercise (-0.6 L/min), followed by a poor chronotropic response (-0.3 L/min) and by a poor right ventricular contractility (-0.2 L/min). LVAD speed increase better unloads the left ventricle and improves total cardiac output in all the simulated conditions. The most substantial benefits from LVAD speed increase were observed in case of poor left ventricular contractility (TCO +1.6 l/min) and vascular dysfunction (TCO +1.4 l/min) followed by lower heartrate (TCO +1.3 l/min) and impaired right ventricular contractility (TCO +1.1 l/min). Despite the presence of the LVAD, exercise hemodynamic is strongly depending on the ability of the cardiovascular system to adapt to exercise. A poor left ventricular inotropic response and a poor vascular function can strongly impair cardiac output at exercise. In these conditions LVAD speed increase can be an effective strategy to augment total cardiac output and unload the left ventricle. These results evidence the need to design a physiological LVAD speed controller, tailored on specific patient's needs.
© 2019 International Center for Artificial Organs and Transplantation and Wiley Periodicals, Inc.
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Prioritizing Evidence-based Interventions for Dissemination and Implementation Investments: AHRQ's Model and Experience.
Med Care2019 Oct;57 Suppl 10 Suppl 3():S272-S277. doi: 10.1097/MLR.0000000000001176.
Huppert Jill S, Fournier Alaina K, Bihm Jasmine L, Chang Christine S, Miller Therese L, Nourjah Parivash, Chang Stephanie M, Bierman Arlene S,
Abstract
BACKGROUND:
The Agency for Healthcare Research and Quality (AHRQ) is mandated to implement patient-centered outcomes research (PCOR) to promote safer, higher quality care. With this goal, we developed a process to identify which evidence-based PCOR interventions merit investment in implementation. We present our process and experience to date.
MATERIALS AND METHODS:
AHRQ developed and applied a systematic, transparent, and stakeholder-driven process to identify, evaluate, and prioritize PCOR interventions for broad dissemination and implementation. AHRQ encouraged public nominations, and assessed them against criteria for quality of evidence, potential impact, and feasibility of successful implementation. Nominations with sufficient evidence, impact, and feasibility were considered for funding.
RESULTS:
Between June 2016 and June 2018, AHRQ received 35 nominations from researchers, nonprofit corporations, and federal agencies. Topics covered diverse settings, populations, and clinical areas. Twenty-eight unique PCOR interventions met minimum criteria; 16 of those had moderate to high evidence/impact and were assessed for feasibility. Fourteen topics either duplicated other efforts or lacked evidence on implementation feasibility. Two topics were prioritized for funding (cardiac rehabilitation after myocardial infarction and screening/treatment for unhealthy alcohol use).
CONCLUSIONS:
AHRQ developed replicable criteria, and a transparent and stakeholder-driven framework that attracted a diverse array of nominations. We identified 2 evidence-based practice interventions to improve care with sufficient evidence, impact, and feasibility to justify an AHRQ investment to scale up practice. Other funders, health systems or institutions could use or modify this process to guide prioritization for implementation.
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Nature of Cardiac Rehabilitation Around the Globe.
EClinicalMedicine2019 Aug;13():46-56. doi: 10.1016/j.eclinm.2019.06.006.
Supervia Marta, Turk-Adawi Karam, Lopez-Jimenez Francisco, Pesah Ella, Ding Rongjing, Britto Raquel R, Bjarnason-Wehrens Birna, Derman Wayne, Abreu Ana, Babu Abraham S, Santos Claudia Anchique, Jong Seng K, Cuenza Lucky, Yeo Tee Joo, Scantlebury Dawn, Andersen Karl, Gonzalez Graciela, Giga Vojislav, Vulic Dusko, Vataman Eleonora, Cliff Jacqueline, Kouidi Evangelia, Yagci Ilker, Kim Chul, Benaim Briseida, Estany Eduardo Rivas, Fernandez Rosalia, Radi Basuni, Gaita Dan, Simon Attila, Chen Ssu-Yuan, Roxburgh Brendon, Martin Juan Castillo, Maskhulia Lela, Burdiat Gerard, Salmon Richard, Lomelí Hermes, Sadeghi Masoumeh, Sovova Eliska, Hautala Arto, Tamuleviciute-Prasciene Egle, Ambrosetti Marco, Neubeck Lis, Asher Elad, Kemps Hareld, Eysymontt Zbigniew, Farsky Stefan, Hayward Jo, Prescott Eva, Dawkes Susan, Santibanez Claudio, Zeballos Cecilia, Pavy Bruno, Kiessling Anna, Sarrafzadegan Nizal, Baer Carolyn, Thomas Randal, Hu Dayi, Grace Sherry L,
Abstract
Background:
Cardiac rehabilitation (CR) is a clinically-effective but complex model of care. The purpose of this study was to characterize the nature of CR programs around the world, in relation to guideline recommendations, and compare this by World Health Organization (WHO) region.
Methods:
In this cross-sectional study, a piloted survey was administered online to CR programs globally. Cardiac associations and local champions facilitated program identification. Quality (benchmark of ? 75% of programs in a given country meeting each of 20 indicators) was ranked. Results were compared by WHO region using generalized linear mixed models.
Findings:
111/203 (54.7%) countries in the world offer CR; data were collected in 93 (83.8%; N?=?1082 surveys, 32.1% program response rate). The most commonly-accepted indications were: myocardial infarction (n?=?832, 97.4%), percutaneous coronary intervention (n?=?820, 96.1%; 0.10), and coronary artery bypass surgery (n?=?817, 95.8%). Most programs were led by physicians (n?=?680; 69.1%). The most common CR providers (mean?=?5.9?±?2.8/program) were: nurses (n?=?816, 88.1%; low in Africa, p?
Interpretation:
This first-ever survey of CR around the globe suggests CR quality is high. However, there is significant regional variation, which could impact patient outcomes.
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Cardiac Rehabilitation Availability and Density around the Globe.
EClinicalMedicine2019 Aug;13():31-45. doi: 10.1016/j.eclinm.2019.06.007.
Turk-Adawi Karam, Supervia Marta, Lopez-Jimenez Francisco, Pesah Ella, Ding Rongjing, Britto Raquel R, Bjarnason-Wehrens Birna, Derman Wayne, Abreu Ana, Babu Abraham S, Santos Claudia Anchique, Jong Seng Khiong, Cuenza Lucky, Yeo Tee Joo, Scantlebury Dawn, Andersen Karl, Gonzalez Graciela, Giga Vojislav, Vulic Dusko, Vataman Eleonora, Cliff Jacqueline, Kouidi Evangelia, Yagci Ilker, Kim Chul, Benaim Briseida, Estany Eduardo Rivas, Fernandez Rosalia, Radi Basuni, Gaita Dan, Simon Attila, Chen Ssu-Yuan, Roxburgh Brendon, Martin Juan Castillo, Maskhulia Lela, Burdiat Gerard, Salmon Richard, Lomelí Hermes, Sadeghi Masoumeh, Sovova Eliska, Hautala Arto, Tamuleviciute-Prasciene Egle, Ambrosetti Marco, Neubeck Lis, Asher Elad, Kemps Hareld, Eysymontt Zbigniew, Farsky Stefan, Hayward Jo, Prescott Eva, Dawkes Susan, Santibanez Claudio, Zeballos Cecilia, Pavy Bruno, Kiessling Anna, Sarrafzadegan Nizal, Baer Carolyn, Thomas Randal, Hu Dayi, Grace Sherry L,
Abstract
Background:
Despite the epidemic of cardiovascular disease and the benefits of cardiac rehabilitation (CR), availability is known to be insufficient, although this is not quantified. This study ascertained CR availability, volumes and its drivers, and density.
Methods:
A survey was administered to CR programs globally. Cardiac associations and local champions facilitated program identification. Factors associated with volumes were assessed using generalized linear mixed models, and compared by World Health Organization region. Density (i.e. annual ischemic heart disease [IHD] incidence estimate from Global Burden of Disease study divided by national CR capacity) was computed.
Findings:
CR was available in 111/203 (54.7%) countries; data were collected in 93 (83.8% country response; N?=?1082 surveys, 32.1% program response rate). Availability by region ranged from 80.7% of countries in Europe, to 17.0% in Africa (p?
Interpretation:
CR is available in only half of countries globally. Where offered, capacity is grossly insufficient, such that most patients will not derive the benefits associated with participation.
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What and Where in the World Is Cardiac Rehabilitation?
EClinicalMedicine -
Acute effects of aerobic exercise on the blood pressure of patients after coronary artery bypass grafting.
Am J Cardiovasc Dis2019 ;9(4):28-33.
de Jesus Furtado Almeida Fabiano, Gambassi Bruno Bavaresco, Sauaia Bismarck Ascar, Almeida Ana Eugênia Araújo Furtado, Ribeiro Daniela Alves Flexa, de Sousa Phabullo Rocha, Chaves Luiz Filipe Costa, da Silva Sousa Thiago Matheus, da Silva Nina Vinicius Jose,
Abstract
BACKGROUND:
Coronary artery bypass grafting a frequent surgical procedure to treat coronary heart disease, uses the patient's own veins or arteries to bypass narrowed areas and restore blood flow to heart muscle. Cardiac rehabilitation follows this procedure and includes psychological and nutritional support along with the regular practice of physical exercises.
OBJECTIVE:
The aim of this study was to investigate the acute effects of the aerobic exercise on the blood pressure of patients after coronary artery bypass grafting.
METHODS:
After 30 days of surgical procedure, 14 patients were assigned to the aerobic exercise group (exercise on the cycle ergometer for 35 minutes), while 8 patients were assigned to the control group (absolute rest for 35 minutes). Blood pressure was measured by a digital automatic device before and after 24 hours of the experiment in both groups.
RESULTS:
Systolic (P = 0.639) and diastolic (P = 0.103) blood pressures were similar between CG and AEG at baseline. Regarding intragroup differences, no significant changes were observed after 24 hours for SBP in the CG (P = 0.999) and AEG (P = 0.244). On the other hand, significant changes were found for DBP after 24 hours for the CG (P = 0.007) and AEG (P = 0.015). When CG and AEG were compared after 24 hours, no significant differences were found for SBP (P = 0.999) and DBP (P = 0.054).
CONCLUSIONS:
We found decreased diastolic blood pressure in the aerobic exercise group when the results for pre-training and post-training were compared. However, to support our findings further research is needed, preferably using randomized controlled trials.
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Mediated effects of insomnia, psychological distress and medication adherence in the association of eHealth literacy and cardiac events among Iranian older patients with heart failure: a longitudinal study.
Eur J Cardiovasc Nurs2019 Sep;():1474515119873648. doi: 10.1177/1474515119873648.
Lin Chung-Ying, Ganji Maryam, Griffiths Mark D, Bravell Marie Ernsth, Broström Anders, Pakpour Amir H,
Abstract
BACKGROUND:
Given the importance of improving health for patients with heart failure, the present study examined the temporal associations between eHealth literacy, insomnia, psychological distress, medication adherence, quality of life and cardiac events among older patients with heart failure.
METHODS:
With a longitudinal design older patients with echocardiography verified heart failure (=468; 50.4% New York Heart Association class II, mean age 69.3±7.3 years; 238 men) in need of cardiac care at seven Iranian university outpatient clinics went through clinical examinations and completed the following questionnaires at baseline: eHealth literacy scale (eHEALS, assessing eHealth literacy); 5-item medication adherence report scale (MARS-5, assessing medication adherence); Minnesota living with heart failure questionnaire (MLHFQ, assessing quality of life); insomnia severity index (ISI, assessing insomnia); and hospital anxiety and depression scale (HADS, assessing psychological distress). All the patients completed the ISI and HADS again 3 months later; and the MARS-5 6 months later. Also, their cardiac events were collected 18 months later. Three mediation models were then conducted.
RESULTS:
eHealth literacy had direct and indirect effects (through insomnia and psychological distress) on medication adherence and quality of life. Moreover, eHealth literacy had protecting effects on cardiac events (hazard ratio (HR) 0.53; 95% confidence interval (CI) 0.37, 0.65) through the mediators of insomnia (HR 0.19; 95% CI 0.15, 0.26), psychological distress (HR 0.08; 95% CI 0.05, 0.12) and medication adherence (HR 0.05; 95% CI 0.04, 0.08).
CONCLUSION:
As eHealth literacy was a protector for patients with heart failure, healthcare providers may plan effective programmes to improve eHealth literacy for the population. Additional benefits of improving eHealth literacy in heart failure may be decreased insomnia and psychological distress, improved quality of life, as well as decreased cardiovascular events.
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Antiangiogenesis effect of timosaponin AIII on HUVECs in vitro and zebrafish embryos in vivo.
Acta Pharmacol Sin2019 Sep;():. doi: 10.1038/s41401-019-0291-z.
Zhou Zhong-Yan, Zhao Wai-Rong, Xiao Ying, Zhou Xiang-Ming, Huang Chen, Shi Wen-Ting, Zhang Jing, Ye Qing, Chen Xin-Lin, Tang Jing-Yi,
Abstract
Timosaponin AIII (Timo AIII) is a natural steroidal saponin isolated from the traditional Chinese herb Anemarrhena asphodeloides Bge with proved effectiveness in the treatment of numerous cancers. However, whether Timo AIII suppresses tumor angiogenesis remains unclear. In the present study, we investigated the antiangiogenesis effects of Timo AIII and the underlying mechanisms in human umbilical vein endothelial cells (HUVECs) in vitro and zebrafish embryos in vivo. We showed that treatment with Timo AIII (0.5-2?µM) partially disrupted the intersegmental vessels (ISVs) and subintestinal vessels (SIVs) growth in transgenic zebrafish Tg(fli-1a: EGFP). Timo AIII (0.5-4?µM) dose-dependently inhibited VEGF-induced proliferation, migration, invasion, and tube formation of HUVECs, but these inhibitory effects were not due to its cytotoxicity. We further demonstrated that Timo AIII treatment significantly suppressed the expression of VEGF receptor (VEGFR) and the phosphorylation of Akt, MEK1/2, and ERK1/2 in HUVECs. Timo AIII treatment also significantly inhibited VEGF-triggered phosphorylation of VEGFR2, Akt, and ERK1/2 in HUVECs. Moreover, we conducted RNA-Seq and analyzed the transcriptome changes in both HUVECs and zebrafish embryos following Timo AIII treatment. The coexpression network analysis results showed that various biological processes and signaling pathways were enriched including angiogenesis, cell motility, cell adhesion, protein serine/threonine kinase activity, transmembrane signaling receptor activity, growth factor activity, etc., which was consistent with the antiangiogenesis effects of Timo AIII in HUVECs and zebrafish embryos. We conclude that the antiangiogenesis effect of Timo AIII is mediated through VEGF/PI3K/Akt/MAPK signaling cascade; Timo AIII potentially exerts antiangiogenesis effect in cancer treatment.
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Reducing Caregiver Distress and Cardiovascular Risk: A Focus on Caregiver-Patient Relationship Quality.
Can J Cardiol2019 Aug;():. doi: S0828-282X(19)30341-1.
Bouchard Karen, Greenman Paul S, Pipe Andrew, Johnson Susan M, Tulloch Heather,
Abstract
Spouses report elevated levels of distress upon assuming a caregiver role; this role and related distress might, ironically, increase the cardiovascular risk of spousal caregivers of patients with cardiovascular disease (CVD). Physiological, behavioural, and emotional factors experienced by caregivers can contribute to enhanced CVD risk. Despite an appreciation of these established associations few approaches have shown effectiveness in reducing a caregiver's stress. It is known that CVD can produce additional strain on a caregiver-patient relationship, in turn accentuating caregiver distress. Poor relationships are known to be a detriment to cardiovascular health and negatively influence behaviours affecting CVD risk and outcomes. In light of these findings, we argue in this nonsystematic narrative review that enhancing caregiver-patient relationship quality in secondary prevention programs might afford an appropriate and timely opportunity to reduce caregiver distress and improve the cardiovascular health of the patient and their spousal caregiver. Evaluations of the effect of couples-based interventions on patient and caregiver CVD risk and health outcomes are required.
Copyright © 2019 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.
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Attending Heart School and long-term outcome after myocardial infarction: A decennial SWEDEHEART registry study.
Eur J Prev Cardiol2019 Sep;():2047487319871714. doi: 10.1177/2047487319871714.
Wallert John, Olsson Erik Mg, Pingel Ronnie, Norlund Fredrika, Leosdottir Margret, Burell Gunilla, Held Claes,
Abstract
BACKGROUND:
The Heart School is a standard component of cardiac rehabilitation after myocardial infarction in Sweden. The group-based educational intervention aims to improve modifiable risks, in turn reducing subsequent morbidity and mortality. However, an evaluation with respect to mortality is lacking.
AIMS:
Using linked population registries, we estimated the association of attending Heart School with both all-cause and cardiovascular mortality, two and five years after admission for first-time myocardial infarction.
METHODS:
Patients with first-time myocardial infarction (<75 years) were identified as consecutively registered in the nationwide heart registry, SWEDEHEART (2006-2015), with >99% complete follow-up in the Causes of Death registry for outcome events. Of 192,059 myocardial infarction admissions, 47,907 unique patients with first-time myocardial infarction surviving to the first cardiac rehabilitation visit constituted the study population. The exposure was attending Heart School at the first cardiac rehabilitation visit 6-10 weeks post-myocardial infarction. Data on socioeconomic status was acquired from Statistics Sweden. After multiple imputation, propensity score matching was performed. The association of exposure with mortality was estimated with Cox regression and survival curves.
RESULTS:
After matching, attending Heart School was associated (hazard ratio (95% confidence interval)) with a markedly lower risk of both all-cause (two-year hazard ratio?=?0.53 (0.44-0.64); five-year hazard ratio?=?0.62 (0.55-0.69)) and cardiovascular (0.50 (0.38-0.65); 0.57 (0.47-0.69)) mortality. The results were robust in several sensitivity analyses.
CONCLUSIONS:
Attending Heart School during cardiac rehabilitation is associated with almost halved all-cause and cardiovascular mortality after first-time myocardial infarction. The result warrants further investigation through adequately powered randomised trials.
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Cross-Cultural Adaptation of the Scale of Auditory Behaviors Questionnaire.
Lang Speech Hear Serv Sch2019 Sep;():1-10. doi: 10.1044/2019_LSHSS-19-0014.
Skar?y?ski Henryk, Bie?kowska Katarzyna, Gos El?bieta, Skar?y?ski Piotr Henryk, Grudzie? Diana, Czajka Natalia, Wo?ujewicz Kinga, W?odarczyk El?bieta,
Abstract
Purpose Children with (central) auditory processing disorder [(C)APD] exhibit many cognitive difficulties and receive negative psychosocial consequences from their disorder. Diagnosis of (C)APD relies on multidisciplinary assessment, including psychological testing. There is a strong need for valid and reliable questionnaires to identify children who are at risk of (C)APD. This work aims to establish the psychometric properties of the Polish version of the Scale of Auditory Behaviors (SAB; Domitz & Schow, 2000; Krzeszewska & Kurkowski, 2015; Miranda, Bruera, & Serra 2016; Musiek & Chermak, 2007; Nunes et al., 2013) as a screening tool in children. Method The SAB was administered to parents of 326 children (152 girls and 174 boys) aged from 6 to 12 years ( = 8.24, = 1.56). The questionnaire consists of 12 items related to various symptoms of (C)APD and allows the frequency of particular behaviors to be assessed. In addition, the questionnaire Children's Home Inventory for Listening Difficulties was administered to parents, and 3 other psychoacoustic behavioral tests (Frequency Pattern Test, Duration Pattern Test, Dichotic Digit Test; Czajka et al., 2012) were conducted on the children to evaluate their auditory abilities. Results The Polish version of SAB demonstrated high internal consistency (Cronbach's ? = .93), confirmed by interitem correlations. Intraclass correlation, which was used to determine reproducibility, was .95. There were also significant and positive relationships, ranging from = .17 to .68, between the SAB score and scores of other measures, indicating convergent validity of the tool. Girls demonstrated higher SAB scores than boys ( < .05); however, age was not statistically significant. A ceiling effect was detected, but no floor effect. Conclusions Results of psychometric and statistical analyses suggest the Polish version of SAB appears to be a valid and reliable questionnaire to evaluate symptoms of (C)APD in children, especially as a screening tool.
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A prospective study on gait dominant normal pressure hydrocephalus.
Acta Neurol Scand2019 Sep;():. doi: 10.1111/ane.13165.
Zavar Reihaneh, Amirpour Afshin, Shahabi Javad,
Abstract
We read with great interest a recent published article by Song et al. entitled "A prospective study on gait dominant normal pressure hydrocephalus". In this study, the authors investigated gait impairments in patients who underwent a lumbar puncture (LP) followed by ventriculoperitoneal shunt placement. In this regard, they investigated the 15 physical therapy assessments in one sample of 28 patients during pre-LP, post-LP, and post-shunt 6-months follow-up.
© 2019 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.
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JCS 2017/JHFS 2017 Guideline on Diagnosis and Treatment of Acute and Chronic Heart Failure?- Digest Version.
Circ J2019 Sep;():. doi: 10.1253/circj.CJ-19-0342.
Tsutsui Hiroyuki, Isobe Mitsuaki, Ito Hiroshi, Ito Hiroshi, Okumura Ken, Ono Minoru, Kitakaze Masafumi, Kinugawa Koichiro, Kihara Yasuki, Goto Yoichi, Komuro Issei, Saiki Yoshikatsu, Saito Yoshihiko, Sakata Yasushi, Sato Naoki, Sawa Yoshiki, Shiose Akira, Shimizu Wataru, Shimokawa Hiroaki, Seino Yoshihiko, Node Koichi, Higo Taiki, Hirayama Atsushi, Makaya Miyuki, Masuyama Tohru, Murohara Toyoaki, Momomura Shin-Ichi, Yano Masafumi, Yamazaki Kenji, Yamamoto Kazuhiro, Yoshikawa Tsutomu, Yoshimura Michihiro, Akiyama Masatoshi, Anzai Toshihisa, Ishihara Shiro, Inomata Takayuki, Imamura Teruhiko, Iwasaki Yu-Ki, Ohtani Tomohito, Onishi Katsuya, Kasai Takatoshi, Kato Mahoto, Kawai Makoto, Kinugasa Yoshiharu, Kinugawa Shintaro, Kuratani Toru, Kobayashi Shigeki, Sakata Yasuhiko, Tanaka Atsushi, Toda Koichi, Noda Takashi, Nochioka Kotaro, Hatano Masaru, Hidaka Takayuki, Fujino Takeo, Makita Shigeru, Yamaguchi Osamu, Ikeda Uichi, Kimura Takeshi, Kohsaka Shun, Kosuge Masami, Yamagishi Masakazu, Yamashina Akira, ,
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