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Pubblicazioni recenti - cardiac rehabilitation
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Depressive symptoms interfere with the improvement in exercise capacity by cardiac rehabilitation after left ventricular assist device implantation.
Artif Organs2021 Sep;():. doi: 10.1111/aor.14072.
Kitagaki Kazufumi, Ono Rei, Shimada Yukihiro, Yanagi Hidetoshi, Konishi Harumi, Nakanishi Michio,
Abstract
BACKGROUND:
Although depressive symptoms are associated with an increased risk of readmission after left ventricular assist device (LVAD) implantation, it is unclear whether they affect the efficacy of exercise-based cardiac rehabilitation (EBCR). This study aimed to investigate the effect of depressive symptoms on EBCR efficacy.
METHODS:
We analyzed 48 patients who participated in EBCR after LVAD implantation (mean age 45±12 years; 60% male). Patients were classified into two groups using the Zung Self-Rating Depression Scale (SDS): depressive group (SDS?40, n=27) and non-depressive group (SDS
RESULTS:
Although baseline characteristics were similar between the two groups, the non-depressive group was less likely to receive diuretics (22% vs. 52%, p=0.030). Peak VO , KEMS, and QOL significantly increased over time in both groups (all p
CONCLUSIONS:
Although EBCR significantly improved exercise capacity after LVAD implantation, depressive symptoms interfered with this improvement. Further studies are needed to determine whether psychological interventions for depression, in addition to EBCR, would improve the response to EBCR after LVAD implantation.
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Randomised controlled trial into the role of ramipril in fibrosis reduction in rheumatic heart disease: the RamiRHeD trial protocol.
BMJ Open2021 Sep;11(9):e048016. doi: 10.1136/bmjopen-2020-048016.
Ambari Ade Meidian, Setianto Budhi, Santoso Anwar, Radi Basuni, Dwiputra Bambang, Susilowati Eliana, Tulrahmi Fadilla, Wind Annemiek, Cramer Maarten Jan Maria, Doevendans Pieter,
Abstract
INTRODUCTION:
Rheumatic heart disease (RHD) is a major burden in developing countries and accounts for 80% of all people living with the disease, where it causes most cardiovascular morbidity and mortality in children and young adults. Chronic inflammation and fibrosis of heart valve tissue due to chronic inflammation in RHD will cause calcification and thickening of the impacted heart valves, especially the mitral valve. This fibrogenesis is enhanced by the production of angiotensin II by increased transforming growth factor ? expression and later by the binding of interleukin-33, which is known to have antihypertrophic and antifibrotic effects, to soluble sST2. sST2 binding to this non-natural ligand worsens fibrosis. Therefore, we hypothesise that ACE inhibitors (ACEIs) would improve rheumatic mitral valve stenosis.
METHODS AND ANALYSIS:
This is a single-centre, double-blind, placebo-controlled, randomised clinical trial with a pre-post test design. Patients with rheumatic mitral stenosis and valve dysfunction will be planned for cardiac valve replacement operation and will be given ramipril 5?mg or placebo for a minimum of 12 weeks before the surgery. The expression of ST2 in the mitral valve is considered to be representative of cardiac fibrosis. Mitral valve tissue will be stained by immunohistochemistry to ST2. Plasma ST2 will be measured by ELISA. This study is conducted in the Department of Cardiology and Vascular Medicine, Universitas Indonesia, National Cardiac Center Harapan Kita Hospital, Jakarta, Indonesia, starting on 27 June 2019.
ETHICS AND DISSEMINATION:
The performance and dissemination of this study were approved by the ethics committee of National Cardiovascular Center Harapan Kita with ethical code LB.02.01/VII/286/KEP.009/2018.
TRIAL REGISTRATION NUMBER:
NCT03991910.
© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.
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Twelve weeks of water-based circuit training exercise improves fitness, body fat and leg strength in people with stable coronary heart disease: a randomised trial.
J Physiother2021 Sep;():. doi: S1836-9553(21)00092-8.
Scheer Anna, Shah Amit, Ito Ramos de Oliveira Beatriz, Moreno-Suarez Ignacio, Jacques Angela, Green Daniel, Maiorana Andrew,
Abstract
QUESTION:
In people with stable coronary heart disease, what are the effects of water-based circuit training exercise on aerobic capacity, strength and body composition? How do these effects compare with those of gym-based exercise?
DESIGN:
Parallel group, randomised controlled trial with concealed allocation and intention-to-treat analysis.
PARTICIPANTS:
Fifty-two participants with stable coronary heart disease.
INTERVENTIONS:
Twelve weeks of: three 1-hour sessions per week of moderate-intensity water-based circuit training exercise with alternating aerobic and resistance stations (WEX); three 1-hour sessions per week of moderate-intensity gym-based circuit training exercise (GEX); or continuing usual activities (control).
OUTCOME MEASURES:
Aerobic capacity (VO), upper and lower limb one repetition maximum strength (biceps curl, latissimus dorsi pulldown, hamstring curl and leg press), anthropometry (weight, body mass index and girth) and dual energy x-ray absorptiometry.
RESULTS:
Forty-five participants completed the study (WEX n = 15, GEX n = 18, control n = 12). Both training groups significantly improved VO compared with control: WEX by 2.5 ml/kg/min (95% CI 0.6 to 4.4) and GEX by 2.3 ml/kg/min (95% CI 0.6 to 4.0). WEX and GEX improved hamstring strength compared with control: WEX by 6.3 kg (95% CI 1.2 to 11.3) and GEX by 7.6 kg (95% CI 2.9 to 12.2). Compared with control, GEX increased leg press strength by 15.5 kg (95% CI 5.7 to 25.3), whereas the effect of WEX was less clear (MD 7.1 kg, 95% CI -3.5 to 17.7). Only GEX improved latissimus dorsi pulldown strength. Compared with control, total body fat was reduced with WEX (-1.1 kg, 95% CI -2.3 to 0.0) and GEX (-1.2 kg, 95% CI -2.3 to -0.1). There were negligible between-group differences in weight or waist circumference.
CONCLUSION:
WEX was well tolerated and improved aerobic capacity, leg strength and body fat to a similar degree as GEX in people with coronary heart disease. These findings suggest that WEX is an effective exercise training alternative to GEX for people with coronary heart disease.
TRIAL REGISTRATION:
ANZCTR12616000102471.
Copyright © 2021 Australian Physiotherapy Association. Published by Elsevier B.V. All rights reserved.
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The novel effectiveness of Tai Chi on cardiopulmonary fitness among stroke patients in the recovery phase: a study protocol for a randomized controlled trial.
Trials2021 Sep;22(1):614. doi: 10.1186/s13063-021-05565-2.
Tan Tianyang, Meng Yanyan, Li Xinyu, Bai Ruina, Wang Chengchao, Lyu Jiaxuan, Yan Kang, Liu Meng, Zhang Chaoyang, Wei Yulong,
Abstract
BACKGROUND:
Stroke is the leading cause of death worldwide. China faces a similar risk of stroke as developed countries because of considerable changes in lifestyle, such as overeating and smoking. Tai Chi is a traditional form of mind-body exercise that has been widely practiced in China for thousands of years. However, there are few studies on the effect of Tai Chi on the cardiopulmonary function of stroke patients in the recovery phase. Therefore, it is necessary to observe the effect of Tai Chi on the cardiorespiratory fitness of patients after stroke.
METHODS:
This is a parallel-design, two-arm, analyst assessor-blinded, randomized controlled trial. A total of 226 stroke patients in the recovery phase will be recruited and assigned randomly to a control group or Tai Chi group at a 1:1 ratio. The patients in the Tai Chi group will perform the Tai Chi exercise. The patients in the control group will perform walking exercises. Patients in both groups will receive conventional treatments and healthy education. The primary outcomes will be VO and scores on the MOS item short form health survey (SF-36) scale. Secondary outcomes will include vital capacity (VC), ejection fractions (EF), and cardiac output (CO). The assessments of the tests will be performed at three time points (before exercise, at the end of exercise, and 6?weeks after exercise). Adverse events will be recorded faithfully during the study.
DISCUSSION:
If the results are positive, this study will contribute to the establishment of further guided Tai Chi rehabilitation programs.
TRIAL REGISTRATION:
Chinese Clinical Trial Registry ChiCTR2000034719 . Registered on 16 July 2020.
© 2021. The Author(s).
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Preclinical short QT syndrome models: studying the phenotype and drug-screening.
Europace2021 Sep;():. doi: euab214.
Fan Xuehui, Yang Guoqiang, Kowitz Jacqueline, Duru Firat, Saguner Ardan M, Akin Ibrahim, Zhou Xiaobo, El-Battrawy Ibrahim,
Abstract
Cardiovascular diseases are the main cause of sudden cardiac death (SCD) in developed and developing countries. Inherited cardiac channelopathies are linked to 5-10% of SCDs, mainly in the young. Short QT syndrome (SQTS) is a rare inherited channelopathy, which leads to both atrial and ventricular tachyarrhythmias, syncope, and even SCD. International European Society of Cardiology guidelines include as diagnostic criteria: (i) QTc ? 340 ms on electrocardiogram, (ii) QTc ? 360 ms plus one of the follwing, an affected short QT syndrome pathogenic gene mutation, or family history of SQTS, or aborted cardiac arrest, or family history of cardiac arrest in the young. However, further evaluation of the QTc ranges seems to be required, which might be possible by assembling large short QT cohorts and considering genetic screening of the newly described pathogenic mutations. Since the mechanisms underlying the arrhythmogenesis of SQTS is unclear, optimal therapy for SQTS is still lacking. The disease is rare, unclear genotype-phenotype correlations exist in a bevy of cases and the absence of an international short QT registry limit studies on the pathophysiological mechanisms of arrhythmogenesis and therapy of SQTS. This leads to the necessity of experimental models or platforms for studying SQTS. Here, we focus on reviewing preclinical SQTS models and platforms such as animal models, heterologous expression systems, human-induced pluripotent stem cell-derived cardiomyocyte models and computer models as well as three-dimensional engineered heart tissues. We discuss their usefulness for SQTS studies to examine genotype-phenotype associations, uncover disease mechanisms and test drugs. These models might be helpful for providing novel insights into the exact pathophysiological mechanisms of this channelopathy and may offer opportunities to improve the diagnosis and treatment of patients with SQT syndrome.
Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2021. For permissions, please email: journals.permissions@oup.com.
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Improved Recovery Protocols in Cardiac Surgery: A Systematic Review and Meta-Analysis of Observational and Quasi-Experimental Studies.
MEDICC Rev;23(3-4):46-53. doi: 10.37757/MR2021.V23.N3.9.
Agüero-Martínez María O, Tapia-Figueroa Víctor M, Hidalgo-Costa Tania,
Abstract
INTRODUCTION:
Improved recovery protocols were implemented in surgical specialties over the last decade, which decreased anesthetic and surgical stress and the incidence of perioperative complications. However, these recovery protocols were introduced more slowly for cardiac surgeries. The most frequent complications in cardiac surgery are related to patient clinical status and the characteristics of the surgical procedures involved, which are becoming more varied and complex every day. The first version of the enhanced recovery program for cardiac surgery was published in 2019, but its recommendations were based on only a few studies, and scant research has evaluated its implementation. Randomized and controlled clinical trials for these protocols are scarce, so research that summarizes the results of studies with other methodological designs are useful in demonstrating their benefits in cardiovascular surgery services in Cuba and in other limited-resource settings.
OBJECTIVE:
Estimate the effectiveness of improved recovery protocols in the perioperative evolution of patients undergoing cardiac surgery.
METHODS:
We performed a systematic review and meta-analysis according to the guidelines of manual 5.1.0 for reviews of the Cochrane library. We included observational and quasi-experimental studies published from January 2015 through May 2020 that compared enhanced recovery protocols with conventional treatments in patients older than 18 years, and used a quality score to evaluate them. We used the following sources: the Cochrane Library, PubMed, LILACS, SciELO, EBSCO, Google Scholar, Web of Science, Clinical Key, ResearchGate and HINARI. The following keywords were used for the database searches in English: ERAS, protocols and cardiac surgery, enhanced recovery after cardiac surgery, ERACS, clinical pathway recovery and cardiac surgery, perioperative care and cardiac surgery. We used the following search terms for databases in Spanish: protocolos de recuperación precoz and cirugía cardiaca, protocolos de recuperación mejorada and cirugía cardiaca, cuidados perioperatorios and cirugía cardiaca, programas de recuperación precoz and cirugía cardiovascular. Methodological quality of included investigations was evaluated using the surgical research methodology scale. Meta-analyses were performed for perioperative complications, intensive care unit and hospital stays, and hospital readmission within 30 days of surgery. We calculated effect sizes of the interventions and the corresponding 95% confidence intervals. We used mean differences and confidence intervals for continuous variables, and for qualitative variables we calculated relative risk (RR). Random effects analysis was used. Heterogeneity of the studies was assessed using the Q statistic and the I2 statistic.
RESULTS:
We selected 15 studies (a total of 5059 patients: study group, n = 1706; control group, n = 3353). The average quality score for the 15 articles included was 18.9 (out of a maximum of 36 according to the scale) and 66.6% had a score =18. With improved recovery protocols in cardiac surgery, the incidence of perioperative complications decreased (RR = 0.73; 95% CI 0.52-0.98) as did hospital readmission within 30 days after surgery (RR = 0.51; 95% CI 95% CI: 0.31-0.86). Differences in extubation time, hospital stay and length of stay in intensive care units were less marked, but always favored the group in which the enhanced protocols were implemented.
CONCLUSIONS:
Improved recovery protocols in cardiac surgery increase quality of care evidenced by reductions in perioperative complications and decreased incidence of hospital readmission in the month following surgery.
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Determinants of Functional Improvement After Cardiac Rehabilitation in Acute Coronary Syndrome.
High Blood Press Cardiovasc Prev2021 Sep;():. doi: 10.1007/s40292-021-00473-7.
Bianchi Sofia, Maloberti Alessandro, Peretti Alessio, Garatti Laura, Palazzini Matteo, Occhi Lucia, Bassi Ilaria, Sioli Sabrina, Biolcati Marco, Giani Valentina, Monticelli Massimiliano, Leidi Filippo, Ruzzenenti Giacomo, Beretta Giovanna, Giannattasio Cristina, Riccobono Salvatore,
Abstract
INTRODUCTION:
Cardiac rehabilitation (CR) is an effective tool for secondary prevention after acute coronary syndrome (ACS).
AIM:
Aim of our study was to find the significant determinants of exercise capacity (evaluated with the six-minute walking test-6-MWT) and functional improvement in patients undergoing CR after an ACS.
METHODS:
The study group included 298 patients (mean age 61.6 ± 10.2 years; males 80.2%) who, after ACS, were enrolled in CR program at Niguarda Hospital in Milan from 2015 to 2018. For all patients, we collected anamnestic, clinical and instrumental cardiological data. All patients performed a 6-MWT at the beginning (6-MWT-1) and at the end (6-MWT-2) of CR program. ? meters were used to represent functional improvement.
RESULTS:
Multiple linear regression models were carried out for 6-MWT-1, 6-MWT-2, ? meters and % ? meters. Standardized regression coefficients showed that age (? = - 0.237; p
CONCLUSIONS:
Our data showed that functional improvement after CR in ACS patients is mainly related to non-cardiological variables. Instead it is related to intrinsic factors, both modifiable (BMI) and non-modifiable (age, sex).
© 2021. The Author(s).
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Clinical and genetic spectrum of a large cohort of patients with ?-sarcoglycan muscular dystrophy.
Brain2021 Sep;():. doi: awab301.
Alonso-Pérez Jorge, González-Quereda Lidia, Bruno Claudio, Panicucci Chiara, Alavi Afagh, Nafissi Shahriar, Nilipour Yalda, Zanoteli Edmar, de Augusto Isihi Lucas Michielon, Melegh Béla, Hadzsiev Kinga, Muelas Nuria, Vílchez Juan J, Dourado Mario Emilio, Kadem Naz, Kutluk Gultekin, Umair Muhammad, Younus Muhammad, Pegorano Elena, Bello Luca, Crawford Thomas O, Suárez-Calvet Xavier, Töpf Ana, Guglieri Michela, Marini-Bettolo Chiara, Gallano Pia, Straub Volker, Díaz-Manera Jordi,
Abstract
Sarcoglycanopathies include four subtypes of autosomal recessive limb-girdle muscular dystrophies (LGMDR3, LGMDR4, LGMDR5 and LGMDR6) that are caused, respectively, by mutations in the SGCA, SGCB, SGCG and SGCD genes. Delta-sarcoglycanopathy (LGMDR6) is the least frequent and is considered an ultra-rare disease. Our aim was to characterize the clinical and genetic spectrum of a large international cohort of LGMDR6 patients and to investigate whether or not genetic or protein expression data could predict diseasés severity. This is a retrospective study collecting demographic, genetic, clinical and histological data of patients with genetically confirmed LGMDR6 including protein expression data from muscle biopsies. We contacted 128 pediatric and adult neuromuscular units around the world that reviewed genetic data of patients with a clinical diagnosis of a neuromuscular disorder. We identified 30 patients with a confirmed diagnosis of LGMDR6 of which 23 patients were included in this study. Eighty seven percent of the patients had consanguineous parents. Ninety one percent of the patients were symptomatic at the time of the analysis. Proximal muscle weakness of the upper and lower limbs was the most common presenting symptom. Distal muscle weakness was observed early over the course of the disease in 56.5% of the patients. Cardiac involvement was reported in 5 patients (21.7%) and 4 patients (17.4%) required non-invasive ventilation. Sixty percent of patients were wheelchair-bound since early teens (median age of 12.0?years old). Patients with absent expression of the sarcoglycan complex on muscle biopsy had a significant earlier onset of symptoms and an earlier age of loss of ambulation compared to patients with residual protein expression. This study confirmed that delta-sarcoglycanopathy is an ultra-rare neuromuscular condition and described the clinical and molecular characteristics of the largest yet-reported collected cohort of patients. Our results showed that this is a very severe and quickly progressive disease characterized by generalized muscle weakness affecting predominantly proximal and distal muscles of the limbs. Similar to other forms of sarcoglycanopathies, the severity and rate of progressive weakness correlates inversely with the abundance of protein on muscle biopsy.
© The Author(s) (2021). Published by Oxford University Press on behalf of the Guarantors of Brain. All rights reserved. For permissions, please email: journals.permissions@oup.com.
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Prognosis of hemodialysis patients with progressive aortic stenosis: a prospective cohort study.
Ren Replace Ther2021 ;7(1):48. doi: 10.1186/s41100-021-00367-3.
Horiguchi Yoriko, Uemura Kaoru, Aoyama Naoyoshi, Nakajima Shinichi, Asai Tomoki, Motohashi Sachiko, Harada Manae, Ida Maoko, Yoshida Atsushi,
Abstract
Background:
Whether progressive mild to moderate aortic stenosis in hemodialysis patients influences their prognosis has not been elucidated. This prospective cohort study explored whether progressive aortic stenosis predicted the rate of cardiac events and mortality in those patients.
Methods:
A total of 283 consecutive hemodialysis patients (no aortic stenosis, 248; progressive aortic stenosis, 35) underwent echocardiography for assessment of aortic stenosis, with a median follow-up period of 4.1 years. Study endpoints were cardiac events, all-cause mortality, and cardiac death. Kaplan-Meier analysis and multivariate Cox proportional hazard analysis were performed to estimate cardiac events, all-cause mortality, and cardiac death.
Results:
Cumulative cardiac event rate, all-cause mortality rate, and the rate of cardiac death at 3-year follow-up were 44.9%, 40.5%, and 26.4% in patients with progressive aortic stenosis and 22.1%, 19.0%, and 7.5% in those without aortic stenosis, respectively. Kaplan-Meier analysis demonstrated the cumulative rates of cardiac events and all-cause mortality. And cardiac death was significantly higher in patients with progressive aortic stenosis than in those without aortic stenosis. Multivariate Cox proportional hazard analysis revealed that progressive aortic stenosis was predictive of cardiac events (adjusted hazard ratio 2.47; 95% confidence interval 1.38-4.39) and cardiac death (adjusted hazard ratio 4.21; 95% confidence interval 2.10-8.46). Age, physical activity, C-reactive protein, and serum albumin levels-but not progressive aortic stenosis-predicted all-cause mortality.
Conclusions:
The rates of cardiac events and cardiac death were higher in hemodialysis patients with progressive aortic stenosis than in those without aortic stenosis. Furthermore, progressive aortic stenosis predicted cardiac events and cardiac death. Compared with those without aortic stenosis, patients with progressive aortic stenosis had higher all-cause mortality, which was related to their comorbidities. This study was retrospectively registered with University Hospital Medical Information Network Clinical Trials Registry (registration number, UMIN 000024023) at September 12th, 2016.
© The Author(s) 2021.
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Extracorporeal membrane oxygenation treatment for high-risk pulmonary embolism with cardiac arrest in a young adult male.
World J Emerg Med2021 ;12(4):324-326. doi: 10.5847/wjem.j.1920-8642.2021.04.013.
Zhang Zhi-Rong, Zhou Xia-Qing, Fan Zhao-Kun, Shi Yin, Shen Ying-Ying, Zhu Chen, Feng Wen, Wang Ling-Cong,
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Laboratory and Imaging Evaluation of Cardiac Involvement in Patients with Post-Acute COVID-19.
Int J Gen Med2021 ;14():4977-4985. doi: 10.2147/IJGM.S321156.
Sar?çam Ersin, Dursun Ali Do?an, Türkmen Sar?y?ld?z Gülçin, Can Nalan, Bozkurt Engin, Gönüllü U?ur, Basay Nihal, Türkmen Meral, Denli Abdülaziz, Ünlü Mustafa,
Abstract
Background:
In the post-acute COVID-19 syndrome, many patients suffer from palpitations, effort-associated fatigue, and even sudden death. The mechanism of heart involvement in this syndrome is uncertain. The main purpose of the study was to identify possible cardiac involvement causes in patients with post-acute COVID-19 by using biomarkers such as NT-proBNP and nitric oxide (NO) and cardiac imaging modalities.
Methods:
In this cross-sectional study, a total of 105 participants were included according to the existence of symptoms, and 40 of these participants were asymptomatic patients. The ages of the participants ranged from 20 to 50 years. All patients were healthy before COVID-19. The symptoms were defined as palpitations and/or fatigue association with exercise in post-acute COVID-19 term. The comparison of the two groups was made by using biochemical parameters (NT-proBNP, Troponin I, NO) and imaging techniques (echocardiography, cardiovascular magnetic resonance (CMR) and cardiac positron emission tomography (PET)).
Results:
The symptomatic patients had higher NT-proBNP levels compared with asymptomatic patients (132.30±35.15; 76.86±16.79, respectively; p
Conclusion:
We found elevated NT-proNBP levels, low serum NO levels, and increased 18F-FDG uptake on cardiac PET in post-acute COVID syndrome. Cardiac PET could replace or be added to CMR for detecting subtle subacute/chronic myocarditis. The follow-up of patients with post-acute COVID-19 could target the possibility of risk of heart failure.
© 2021 Sar?çam et al.
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Effects of Cardiac Rehabilitation With Lumbar-Type Hybrid Assistive Limb on Muscle Strength in Patients With Chronic Heart Failure?- A Randomized Controlled Trial.
Circ J2021 Sep;():. doi: 10.1253/circj.CJ-21-0381.
Kato Hidenori, Watanabe Hiroki, Koike Akira, Wu Longmei, Hayashi Kosuke, Konno Hirotomo, Machino Takeshi, Nishi Isao, Sato Akira, Kawamoto Hiroaki, Aonuma Kazutaka, Sankai Yoshiyuki, Ieda Masaki,
Abstract
BACKGROUND:
Aiming to establish an effective tool in new cardiac rehabilitation programs, we investigated the use of a lumbar-type hybrid assistive limb (HAL) in patients with heart failure (HF) who had difficulty in walking at the usual speed of healthy subjects (?80 m/min).Methods?and?Results:We randomly assigned 28 HF patients (age, 73.1±13.8 years) to perform a sit-to-stand exercise with or without HAL. The sit-to-stand exercise was repeated as many times as possible as cardiac rehabilitation therapy over a period of 6-10 days. We measured 5 parameters before and after the completion of cardiac rehabilitation: B-type natriuretic peptide, Short Physical Performance Battery (SPPB), 6-min walking distance (6MWD), 30-s chair-stand test (CS-30), and isometric knee extensor muscle strength. The SPPB and 6MWD were significantly improved, and the CS-30 score was somewhat improved, after the exercise therapy in both the HAL and non-HAL groups. The knee extensor muscle strength improved significantly in the HAL group (0.29±0.11 to 0.35±0.11 kgf/kg, P
CONCLUSIONS:
The improved knee extensor muscle strength in the HAL group suggests that the lumbar-type HAL may be an effective tool for cardiac rehabilitation in HF patients with frailty, which is a predictor of poor prognosis in HF.
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The comparison of albumin and 6% hydroxyethyl starches (130/0.4) in cardiac surgery: a meta-analysis of randomized controlled clinical trials.
BMC Surg2021 Sep;21(1):342. doi: 10.1186/s12893-021-01340-x.
Wei Ling, Li Dongping, Sun Lin,
Abstract
BACKGROUND:
Fluid administration is a key tool in the maintenance of normovolemia in patients with cardiac surgery. The trials that evaluated the safety of 6% hydroxyethyl starch (HES) 130/0.4 in cardiac surgical patients were inconsistent. It is necessary to compare the efficacy and safety of albumin and 6% HES (130/0.4).
METHOD:
We searched for the randomized controlled clinical trials that compared human albumin with 6% HES (130/0.4) in cardiac surgery in PubMed, Cochrane, and Embase.
RESULTS:
Ten studies involved a total of 1567 patients were included in our meta-analysis. For the efficiency, there was no difference in total volume of infusion between compared groups [P?=?0.64, Fixed Effect Model (FEM): standardized mean difference (SMD)?=?0.04, 95% confidence interval (CI) (- 0.12, 0.20)]. As for safety, the albumin show more risk than hydroxyethyl starch 130/0.4 in blood loss [P?=?0.02, FEM: SMD: 0.22, 95% CI (0.03, 0.41)]. There was no difference in the frequency of transfusions (P?=?0.20, RR?=?1.11; 95% CI (0.95, 1.27)) between the two groups. No difference was observed for the days in intensive care unit [P?=?0.05, FEM: SMD?=?- 0.18, 95% CI (- 0.36, 0.00)], and the days in hospital [P?=?0.32, FEM: SMD?=?- 0.11, 95% CI (- 0.32, 0.10)]. Furthermore, both the incidence of AKI, RRT, and mortality were comparable in the two groups.
CONCLUSION:
This study provided evidence that the 6% HES (130/0.4) might be the substitute for HA, which reduced the economic burden for patients with cardiac surgery. However, the effect of 6% HES (130/0.4) and HA on AKI still needs to be further studied.
© 2021. The Author(s).
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Increasing Cardiac Rehabilitation Referrals Through an Outpatient Intervention.
J Cardiopulm Rehabil Prev2021 Sep;():. doi: 10.1097/HCR.0000000000000636.
Spindel Jeffrey Fraser, Albers Lauren, Brislin Gregory, Toft Lorrel Elizabeth Brown,
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Update on RFA Increasing Use of Cardiac and Pulmonary Rehabilitation in Traditional and Community Settings NIH-Funded Trials: ADDRESSING CLINICAL TRIAL CHALLENGES PRESENTED BY THE COVID-19 PANDEMIC.
J Cardiopulm Rehabil Prev2021 Sep;():. doi: 10.1097/HCR.0000000000000635.
Shero Susan T, Benzo Roberto, Cooper Lawton S, Finkelstein Joseph, Forman Daniel E, Gaalema Diann E, Joseph Lyndon, Keteyian Steven J, Peterson Pamela N, Punturieri Antonello, Zieman Susan, Fleg Jerome L,
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Intensive Cardiac Rehabilitation Is Markedly Underutilized by Medicare Beneficiaries: RESULTS FROM A 2012-2016 NATIONAL SAMPLE.
J Cardiopulm Rehabil Prev2021 Sep;():. doi: 10.1097/HCR.0000000000000632.
Husaini Mustafa, Deych Elena, Racette Susan B, Rich Michael W, Joynt Maddox Karen E, Peterson Linda R,
Abstract
PURPOSE:
Intensive cardiac rehabilitation (ICR) was developed to enhance traditional cardiac rehabilitation (CR) by adding sessions focused on nutrition, lifestyle behaviors, and stress management. Intensive CR has been Medicare-approved since 2010, yet little is known about national utilization rates of ICR in the Medicare population or characteristics associated with its use.
METHODS:
A 5% sample of Medicare claims data from 2012 to 2016 was used to identify beneficiaries with a qualifying indication for ICR/CR and to quantify utilization of ICR or CR within 1 yr of the qualifying diagnosis.
RESULTS:
From 2012 to 2015, there were 107 246 patients with a qualifying indication. Overall, only 0.1% of qualifying patients participated in ICR and 16.2% in CR from 2012 to 2016, though utilization rates of both ICR and CR increased during this period (ICR 0.06 to 0.17%, CR 14.3 to 18.2%). The number of ICR centers increased from 15 to 50 over the same period. There were no differences between ICR and CR enrollees with respect to age, sex, race, discharge location, median income, dual enrollment, or number of comorbidities. Compared with eligible beneficiaries who did not attend ICR or CR, those who attended either program were younger, more likely to be male and White, and had higher median income.
CONCLUSIONS:
Although ICR and CR have a class 1 indication for the treatment of cardiovascular disease and the number of ICR centers has increased, ICR is not widely available and remains markedly underutilized. Continued research is needed to understand the barriers to program development and patient participation.
Copyright © Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.
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Cardiac Rehabilitation and Resting Blood Pressure: MONTANA OUTCOMES PROJECT CARDIAC REHABILITATION REGISTRY FINDINGS.
J Cardiopulm Rehabil Prev2021 Sep;():. doi: 10.1097/HCR.0000000000000638.
Quindry John C, McNamara Michael, Oser Carrie, Fogle Crystelle,
Abstract
PURPOSE:
Exercise-based cardiac rehabilitation (CR) is essential for treating cardiovascular disease, and modifying risk factor modification, including hypertension. Because the causes of hypertension and benefits of CR are faceted, we examined the influence of phase II CR on resting blood pressure (BP).
METHODS:
Outcomes straddle the release of the updated BP guidelines, and study emphases included CR session number, sex, race/ethnicity, insurance provider, and referring diagnosis.
RESULTS:
Patient files of 31 885 individuals uploaded to the Montana Outcomes Project registry indicated that lowered systolic and diastolic BP were further improved after the release of the revised BP guidelines. The CR session number was proportional to improvements in diastolic BP. Blood pressure improved independent of sex, although female patients exhibited lower diastolic BP before and after CR. Race/ethnicity analyses indicated that Asian and White patients experienced drops in systolic and diastolic BP, while diastolic BP was improved in Hispanic patients. Neither American Indian nor Black patients exhibited statistically altered BP. Medicare, Veterans Administration, and privately insured patients had lowered systolic and diastolic BP, while Medicaid patients had lower diastolic BP, and the uninsured had lower systolic BP. Blood pressure outcomes were generally improved independent of the primary referring diagnosis, while those with peripheral artery disease showed no improvements.
CONCLUSIONS:
Findings demonstrate that phase II CR is highly effective in the control of BP, although improvements are not equally distributed to all individuals according to differences in sex, race/ethnicity, and access to insurance-funded health care.
Copyright © Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.
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Spurred by pedometers, unity and fun exercise: A qualitative study of participation in rehabilitation for patients with intermittent claudication (The CIPIC Rehab study).
J Vasc Nurs2021 Sep;39(3):59-66. doi: S1062-0303(21)00051-0.
Siercke Maj, Berg Selina Kikkenborg, Missel Malene,
Abstract
AIM:
To explore how patients with intermittent claudication experiences participating in a community-based cardiovascular rehabilitation program and the various components of the rehabilitation program.
BACKGROUND:
Intermittent claudication is a condition associated with progressive atherosclerosis that affects daily life. Most patients with intermittent claudication do not exercise even though exercise is essential in the treatment of this condition. Rehabilitation is reported to be effective in alleviating symptoms, increasing walking distance, reducing cardiovascular events, and improving quality of life. Patients' perspectives are important when designing such programs, however, this aspect has not previously been investigated.
DESIGN:
A qualitative study.
METHODS:
Patients with intermittent claudication (n=10) participating in a rehabilitation program were interviewed in two focus groups. Pragmatic philosophy inspired the approach. Data were analyzed using qualitative thematic analysis, and emerging themes were discussed according to self-efficacy theory.
RESULTS:
Participants experienced social support from other patients, which motivated them to exercise. The intervention encouraged the patients' management of leg pain, while a local setting and a pedometer were important motivational factors to keep adherence to the program. The participants' experiences of the rehabilitation program are expressed in four themes revealed from the qualitative analysis: 1) the shared community, 2) pushing your own limits, 3) spurred by pedometers and health professionals, and 4) continuing new habits on your own. The participants found the components in the rehabilitation program meaningful, but encountered difficulties in continuing on their own after completion of the program.
CONCLUSION:
A specialized community-based cardiovascular rehabilitation program for patients with intermittent claudication can be supportive for patients suffering from intermittent claudication.
RELEVANCE TO CLINICAL PRACTICE:
The qualitative results can be used to guide development of existing cardiac rehabilitation programs targeted patients with intermittent claudication in a community setting.
Copyright © 2021 The Authors. Published by Elsevier Inc. All rights reserved.
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Takotsubo syndrome as an overlooked and elusive cause of a single episode of dyspnea in young women: a case report.
BMC Cardiovasc Disord2021 Sep;21(1):430. doi: 10.1186/s12872-021-02239-4.
Lee Sung Eun, Yoon Seung-Hyun, Kang Hyo Jung, Ahn Jung Hwan,
Abstract
BACKGROUND:
Dyspnea is a common symptom in patients presenting to the emergency department. It has a variety of causes that range from non-urgent to life-threatening. One episode of dyspnea in a healthy young person is easy to overlook. However, if the symptoms occur after physically or emotionally stressful events, careful evaluation needs to be undertaken because it may be associated with Takotsubo syndrome, which is rarely expected but can be fatal. Herein, we report the case of Takotsubo syndrome in a healthy young woman who arrived at the emergency department after experiencing a short single episode of dyspnea following a minor surgery.
CASE PRESENTATION:
A 23-year old woman with no underlying chronic disease underwent closed reduction surgery for a nasal bone fracture under general anesthesia (with sevoflurane as the anesthetic). Approximately 5 h later, she presented to the emergency department with dyspnea, which improved soon upon arrival at the emergency department. There were no other symptoms. The dyspnea occurred about 5 h after being discharged on observation, with an uneventful postoperative course. Her electrocardiogram and chest X-ray findings were unremarkable. On testing, troponin I and creatine kinase myocardial band levels were elevated at 6.122 ng/mL and 11.2 µg/L (reference ranges: 0.000-0.046 ng/mL and 0.0-5.0 µg/L), respectively. Bedside echocardiography revealed an ejection fraction of 25%, with mid-ventricular and apical akinesia and basal hyperkinesia. The pulmonary and coronary angiographic computed tomographic scans were unremarkable. Hence, apical Takotsubo syndrome was suspected. A follow-up echocardiogram taken 5 days after admission showed full recovery with a normalized ejection fraction (60%) and no regional wall motion abnormality. The patient was discharged on the sixth day with no other complications.
CONCLUSION:
When atypical symptoms, such as transient dyspnea, manifest, it becomes necessary to suspect and diagnose Takotsubo syndrome to ensure timely and appropriate medical management, especially when a preceding stressful event, such as minor surgery has occurred. It might be helpful to perform bedside point-of-care echocardiography to check for regional wall motion abnormalities that are typically associated with Takotsubo syndrome.
© 2021. The Author(s).
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Cancer and cardiovascular disease: The impact of cardiac rehabilitation and cardiorespiratory fitness on survival.
Int J Cardiol2021 Sep;():. doi: S0167-5273(21)01326-7.
Williamson Tamara, Moran Chelsea, Chirico Daniele, Arena Ross, Ozemek Cemal, Aggarwal Sandeep, Campbell Tavis, Laddu Deepika,
Abstract
BACKGROUND:
Cancer survivors are at increased risk for cardiovascular disease (CVD)-related morbidity and mortality. Exercise-based cardiac rehabilitation (CR) programs improve CVD risk factors, including cardiorespiratory fitness (CRF). The purpose of this study was to investigate: (1) the association between CR completion and survival, and (2) whether CRF improvements translate to increased survival among patients with comorbid cancer and CVD.
METHODS:
Patients with CVD and pre-existing cancer (any type) were referred to a 12-week exercise-based CR program between 01/1996 and 03/2016. Peak metabolic equivalents (METs) were assessed by graded exercise test pre-CR and at 12-weeks. Kaplan-Meier survival and multivariate cox regressions were performed to evaluate impact of CR completion and clinically-meaningful CRF improvements [?METs?1] on survival, adjusting for relevant covariates.
RESULTS:
Among 442 patients with CVD and cancer referred to CR (67 ± 10 years; 22% women), 361 (82%) completed CR. 102 deaths were recorded during the 12-year observation period. Compared to patients who did not complete CR, patients with comorbid cancer who completed CR demonstrated a survival advantage (63% vs 80.1%, p
CONCLUSION:
Completing a 12-week exercise-based CR program improved CRF and increased survival in patients with CVD and comorbid cancer. The results highlight the survival benefits of completing a CR program among CVD patients who experience added barriers imposed by cancer treatment and survival.
Copyright © 2021 Elsevier B.V. All rights reserved.
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