Pubblicazioni recenti - cardiac rehabilitation
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Predictors of postoperative physical functional decline at hospital discharge in elderly patients with prolonged intensive care unit stay after cardiac surgery.
Heart Lung2023 Dec;64():86-92. doi: 10.1016/j.hrtlng.2023.11.014.
Honda Yosuke, Honma Keisuke, Nishimura Shuuji, Nakao Shiomi, Sasanuma Naoki, Manabe Eri, Uchiyama Yuuki, Takahashi Keiko, Sakaguchi Taichi, Domen Kazuhisa,
Abstract
BACKGROUND:
A prolonged stay in the intensive care (ICU) is associated with physical function decline following cardiac surgery. To predict physical function decline after cardiac surgery, it may be important to evaluate physical function in the ICU.
OBJECTIVES:
This study aimed to determine that physical function examination at ICU discharge was independently associated with physical functional decline at hospital discharge in elderly patients who had undergone cardiac surgery and prolonged the ICU stay.
METHODS:
We assessed physical function before and after cardiac surgery in elderly patients who had spent ?72 h in the ICU in this retrospective cohort study using the short physical performance battery (SPPB). At hospital discharge, a decrease of at least 1 point on the SPPB was considered a postoperative physical functional decline. Postoperative physical functional decline at hospital discharge was predicted using multiple logistic regression.
RESULTS:
We revealed postoperative physical functional deterioration in 28.0% of patients who spent ?72 h in the ICU following cardiac surgery. The Medical Research Council sum score (MRC-SS) (OR: 0.96, 95% CI: 0.82-0.99) and mechanical ventilation days (OR: 1.27, 95% CI: 1.01-1.64) were independently associated with physical functional decline at hospital discharge.
CONCLUSIONS:
Physical function at ICU discharge and mechanical ventilation days were predictors of postoperative physical functional decline at hospital discharge in patients. MRC-SS was more accurate in predicting postoperative physical functional decline at hospital discharge when performed at the time of ICU discharge.
Copyright © 2023 Elsevier Inc. All rights reserved.
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Effect of rapid rehabilitation care on surgical site wound infection and pain in patients with intertrochanteric femoral fractures: A meta-analysis.
Int Wound J2023 Dec;():. doi: 10.1111/iwj.14540.
Li Jun-Hong, Li Ping, Li Yao,
Abstract
This study examines the effects of rapid rehabilitation on surgical site wound infections and pain in patients with intertrochanteric femoral fractures. A computerised search was conducted for randomised controlled trials (RCTs) on rapid rehabilitation care in patients undergoing surgery for intertrochanteric femoral fractures published in the China National Knowledge Infrastructure, China Biomedical Literature Database, Wanfang Database, VIP, PubMed, Embase, Cochrane Library and Web of Science. The search was conducted from the time of the database construction to August 2023. Two investigators independently performed literature screening, data extraction and quality assessment based on predefined inclusion and exclusion criteria. Meta-analysis was performed via RevMan 5.4 software. Encompassing 21 studies involving 2004 patients, with 1007 patients receiving rapid rehabilitation care and 997 receiving routine care, our analysis revealed that rapid rehabilitation care significantly reduced postoperative complications (odds ratio [OR]?=?0.24, 95% confidence interval [CI]: 0.17-0.33, p?0.001), wound infections (OR?=?0.30, 95% CI: 0.14-0.65, p?=?0.002) and hospital stay (mean difference [MD]?=?-5.23, 95% CI: -6.03 to -4.43, p?0.001). Moreover, compared with routine care, it notably improved wound pain (MD?=?-1.51, 95% CI: -1.98 to -1.05, p?0.001) in patients undergoing surgery for intertrochanteric femoral fractures. Our findings underscore the effectiveness of rapid rehabilitation care in reducing wound pain, postoperative complications and wound infections among patients with intertrochanteric femoral fractures.
© 2023 The Authors. International Wound Journal published by Medicalhelplines.com Inc and John Wiley & Sons Ltd.
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Calf circumference as a screening tool for low skeletal muscle mass: Cut-off values in independent Thai older adults.
BMC Geriatr2023 Dec;23(1):826. doi: 826.
Champaiboon Jirapa, Petchlorlian Aisawan, Manasvanich Bhorn-Ake, Ubonsutvanich Nattaphon, Jitpugdee Weerachai, Kittiskulnam Piyawan, Wongwatthananart Supharada, Menorngwa Yupaporn, Pornsalnuwat Sasitorn, Praditpornsilpa Kearkiat,
Abstract
BACKGROUND:
Calf circumference is recommended as a marker for low muscle mass and as a case finding in the diagnosis of sarcopenia. However, the cut-off value differed by ethic and region. Currently there is no study among Thai population. Therefore, we aimed to identify the optimal cutoff value of calf circumference as a screening tool for low skeletal muscle mass in independent Thai older adults. Subgroup analysis was performed for obesity and adults over 75 years.
METHODS:
This cross-sectional cohort studied in an outpatient geriatric check-up clinic. Participants, aged 60 and above, needed to be independent in basic activities of daily living to meet the inclusion criteria. Exclusion criteria comprised active malignancy, cardiac, pulmonary, or neurovascular diseases necessitating hospitalization in the preceding three months, chronic renal diseases requiring renal replacement therapy, and unstable psychiatric disorders. We measured the maximum calf circumference and appendicular skeletal muscle mass (ASMI) using bioelectrical impedance analysis (BIA). Low muscle mass is defined according to the Asian Working Group of Sarcopenia (AWGS) 2019 consensus.
RESULTS:
We enrolled 6,404 elderly adults (mean age 67.3?±?5.1 years), with a 47% prevalence of low muscle mass in women and 25% in men. Lower muscle mass significantly correlated with reduced BMI and waist circumference in both genders (p?0.001). Optimal cut-off values for low muscle mass screening were 33 cm (sensitivity 80.1%, specificity 60.5%) for women and 34 cm (sensitivity 85.4%, specificity 70.2%) for men. Subgroup analysis for those with BMI???25 kg/m² suggested raising the cut-off for women to 34 cm (sensitivity 80.6%, specificity 54.0%) and for men to 35 cm (sensitivity 88.7%, specificity 55.2%) to enhance specificity without substantial sensitivity loss. In the older-old adult subgroup (??75 years), optimal cut-off values were 33 cm (sensitivity 84.6%, specificity 79.9%) for women and 34 cm (sensitivity 75.6%, specificity 87.0%) for men.
CONCLUSIONS:
There is a strong correlation between calf circumference and ASMI in independent Thai older adults. Calf circumference can serve as a screening tool for identifying low muscle mass. The recommended cut-off values for men and women are 34 cm and 33 cm, respectively in alignment with AWGS 2019 recommendation. Incorporating a 1-cm higher cut-off value for obese older adults improves the accuracy of muscle mass screening.
TRIAL REGISTRATION:
Thai clinical trial registry: TCTR20200511003.
© 2023. The Author(s).
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Calciphylaxis in a patient with hypoparathyroidism and MEN-1 syndrome.
Endocrinol Diabetes Metab Case Rep2023 Oct;2023(4):. doi: 23-0009.
van Heeswijk Isabelle, Ugur Antonia, Havill Lynsey, Kinton Rebecca, Hughes David,
Abstract
SUMMARY:
Calciphylaxis is a rare disorder characterised by the development of painful necrotic skin lesions. Occlusion of cutaneous arterioles due to ectopic calcification leads to potentially life-threatening widespread skin loss. Most cases occur in patients with chronic renal disease, which leads to dysregulation of calcium and phosphate homeostasis. Only a handful of case reports exist describing calciphylaxis occurring in patients without chronic renal disease but with hypoparathyroidism. We report on a unique case of a 53-year-old man with multiple endocrine neoplasia type 1 syndrome and acquired hypoparathyroidism due to total parathyroidectomy who went on to develop calciphylaxis following cardiac surgery.
LEARNING POINTS:
Calciphylaxis most commonly occurs in the context of chronic renal disease but can rarely occur in its absence as a consequence of calcium and phosphate dysregulation. Patients who develop necrotic skin lesions in the presence of hypoparathyroidism require an urgent dermatological opinion. Mortality from calciphylaxis is high, with the majority of deaths occurring secondary to sepsis. Management of calciphylaxis requires a multidisciplinary team approach to manage wound healing, infections and pain. Recovery with full rehabilitation from calciphylaxis can take months to years.
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Quantifying Improvement in V?o2peak and Exercise Thresholds in Cardiovascular Disease Using Reliable Change Indices.
J Cardiopulm Rehabil Prev2023 Dec;():. doi: 10.1097/HCR.0000000000000837.
Faricier Robin, Keltz Randi R, Hartley Tim, McKelvie Robert S, Suskin Neville G, Prior Peter L, Keir Daniel A,
Abstract
PURPOSE:
Improving aerobic fitness through exercise training is recommended for the treatment of cardiovascular disease (CVD). However, strong justifications for the criteria of assessing improvement in key parameters of aerobic function including estimated lactate threshold (?LT), respiratory compensation point (RCP), and peak oxygen uptake (V?o2peak) at the individual level are not established. We applied reliable change index (RCI) statistics to determine minimal meaningful change (MMCRCI) cutoffs of ?LT, RCP, and V?o2peak for individual patients with CVD.
METHODS:
Sixty-six stable patients post-cardiac event performed three exhaustive treadmill-based incremental exercise tests (modified Bruce) ?1 wk apart (T1-T3). Breath-by-breath gas exchange and ventilatory variables were measured by metabolic cart and used to identify ?LT, RCP, and V?o2peak. Using test-retest reliability and mean difference scores to estimate error and test practice/exposure, respectively, MMCRCI values were calculated for V?o2 (mL·min-1.kg-1) at ?LT, RCP, and V?o2peak.
RESULTS:
There were no significant between-trial differences in V?o2 at ?LT (P = .78), RCP (P = .08), or V?o2peak (P = .74) and each variable exhibited excellent test-retest variability (intraclass correlation: 0.97, 0.98, and 0.99; coefficient of variation: 6.5, 5.4, and 4.9% for ?LT, RCP, and V?o2peak, respectively). Derived from comparing T1-T2, T1-T3, and T2-T3, the MMCRCI for ?LT were 3.91, 3.56, and 2.64 mL·min-1.kg-1; 4.01, 2.80, and 2.79 mL·min-1.kg-1 for RCP; and 3.61, 3.83, and 2.81 mL·min-1.kg-1 for V?o2peak. For each variable, MMCRCI scores were lowest for T2-T3 comparisons.
CONCLUSION:
These MMCRCI scores may be used to establish cutoff criteria for determining meaningful changes for interventions designed to improve aerobic function in individuals with CVD.
Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.
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Blood flow restriction reduces the increases in cardiorespiratory responses and subjective burden without inhibiting muscular activity during cycling at ventilatory threshold in healthy males.
PLoS One2023 ;18(12):e0294524. doi: e0294524.
Uematsu Azusa, Mizushima Yuta, Ishizaka Hayato, Hortobágyi Tibor, Mizushima Takashi, Toyoda Shigeru, Nakajima Toshiaki,
Abstract
Low-intensity endurance exercise with blood flow restriction (KAATSU) is under consideration for use in cardiac rehabilitation. However, the physiological responses to such exercise have not yet been fully characterized. In an initial effort in healthy males (n = 11, age: 26.3±4.6 y), we compared the physiological responses to low-intensity endurance exercise with and without a thigh KAATSU. Participants performed maximal graded exercise testing using a cycle ergometer with or without KAATSU. We examined responses to cycling exercise at ventilatory threshold (VT) in heart rate (HR), oxygen consumption (VO2), dyspnea, ratings of perceived exertion (RPE), blood pressure (BP), and rectus femoris activation. Participants reached VT at a lower mechanical load, HR, VO2, dyspnea, and double product (HR×systolic BP) with KAATSU vs. no-KAATSU. At VT, RPE, and rectus femoris activity did not differ between the two conditions. These results suggest that KAATSU reduced exercise intensity to reach VT and the physiological responses to exercise at VT without changes in knee extensor muscle activation. Results from this pilot study in healthy males suggest that KAATSU aerobic exercise at VT intensity has the potential to be an effective and low-burden adjuvant to cycling in cardiac rehabilitation.
Copyright: © 2023 Uematsu et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
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Transthoracic Ultrasound Improves Cardiac Function in Mice.
IEEE Trans Ultrason Ferroelectr Freq Control2023 Dec;PP():. doi: 10.1109/TUFFC.2023.3341248.
Yi Shasha, Chen Houminji, Lin Zhengrong, Zou Junjie, Huang Xiaowei, Hu Xiquan, Niu Lili,
Abstract
Cardiac dysfunction is a severe complication that is as-sociated with an increased risk of mortality in multiple diseases. One potential solution that has been researched is the electrical stimulation of the vagus nerve to exert cardioprotection. This method has been shown to reduce the systemic inflammatory response and maintain im-mune homeostasis of the heart. However, the invasive procedure of electrode implantation poses a risk of nerve or fiber damage. Here, we propose transthoracic ultrasound stimulation of vagus nerve to allevi-ate cardiac dysfunction caused by lipopolysaccharide. We developed a noninvasive transthoracic ultrasound stimulation system and exposed anesthetized mice to ultrasound protocol or sham stimulation 24 hours after lipopolysaccharide treatment. Results showed that daily heart tar-geting ultrasound stimulation for 4 days significantly increased left ventricular systolic function (p = 0.01) and improved ejection fraction (p = 0.03) and shortening fraction (p = 0.04). Furthermore, ultrasound stimulation significantly reduced inflammation cytokines, including IL-6 (p = 0.03) and IL-1? (p = 0.04). In addition, cervical vagotomy abrogated the effect of ultrasound stimulation, suggesting the involve-ment of the vagus nerve anti-inflammatory effect. Finally, the same ultrasound treatment but for a longer period (14 days) also significantly increased cardiac function in naturally aged mice. Collectively, these findings suggest that the potential of transthoracic ultrasound stimula-tion as a possible novel noninvasive approach in the context of cardiac dysfunction with reduced systolic function, and provide new targets for rehabilitation of peripheral organ function.
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Cardiac Rehabilitation After Hospitalization for Acute Coronary Syndrome.
Curr Cardiol Rep2023 Dec;():. doi: 10.1007/s11886-023-02010-5.
Thakker Ravi, Khan Mahin, Al-Hemyari Bashar,
Abstract
PURPOSE OF REVIEW:
Acute coronary syndrome (ACS) carries a high burden of morbidity and mortality. Cardiac rehabilitation over the past century has developed as an important tool in treating and preventing future myocardial infarction events in this critical group. We summarize the rationale and literature evidence supporting the use of cardiac rehabilitation and its role in ACS patients, with an emphasis on its impact on outcomes following hospitalization.
RECENT FINDINGS:
Current literature and large-scale reviews and registry analyses provide conflicting data on the benefits of cardiac rehabilitation after ACS, including its impact on mortality, readmission, and quality of life. Cardiac rehabilitation is an important tool in the management ACS patients. It encompasses not only a graduated exercise regimen but also a holistic approach and is therefore best implemented as a comprehensive cardiac rehabilitation strategy including, in addition to exercise regimen, psychosocial counseling, smoking cessation education, medication adherence, nutrition guidance, and other tools for risk modification. Further trials on the role of cardiac rehabilitation after ACS are needed, especially trials examining different cardiac rehabilitation protocols, time period for its implementation after ACS, and optimal program duration.
© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.
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Influence of Respiratory Frequency of Slow-Paced Breathing on Vagally-Mediated Heart Rate Variability.
Appl Psychophysiol Biofeedback2023 Dec;():. doi: 10.1007/s10484-023-09605-2.
You Min, Laborde Sylvain, Ackermann Stefan, Borges Uirassu, Dosseville Fabrice, Mosley Emma,
Abstract
Breathing techniques, particularly slow-paced breathing (SPB), have gained popularity among athletes due to their potential to enhance performance by increasing cardiac vagal activity (CVA), which in turn can help manage stress and regulate emotions. However, it is still unclear whether the frequency of SPB affects its effectiveness in increasing CVA. Therefore, this study aimed to investigate the effects of a brief SPB intervention (i.e., 5 min) on CVA using heart rate variability (HRV) measurement as an index. A total of 75 athletes (22 female; M?=?22.32; age range?=?19-31) participated in the study, attending one lab session where they performed six breathing exercises, including SPB at different frequencies (5 cycles per minute (cpm), 5.5 cpm, 6 cpm, 6.5 cpm, 7 cpm), and a control condition of spontaneous breathing. The study found that CVA was significantly higher in all SPB conditions compared to the control condition, as indexed by both root mean square of the successive differences (RMSSD) and low-frequency HRV (LF-HRVms). Interestingly, LF-HRVms was more sensitive in differentiating the respiratory frequencies than RMSSD. These results suggest that SPB at a range of 5 cpm to 7 cpm can be an effective method to increase CVA and potentially improve stress management and emotion regulation in athletes. This short SPB exercise can be a simple yet useful tool for athletes to use during competitive scenarios and short breaks in competitions. Overall, these findings highlight the potential benefits of incorporating SPB into athletes' training and competition routines.
© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.
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Effectiveness of Virtual Reality and Feedback to Improve Gait and Balance in Patients with Diabetic Peripheral Neuropathies: Systematic Review and Meta-Analysis.
Healthcare (Basel)2023 Nov;11(23):. doi: 3037.
Alonso-Enríquez Laura, Gómez-Cuaresma Laura, Billot Maxime, Garcia-Bernal Maria Isabel, Benitez-Lugo Maria Luisa, Casuso-Holgado María Jesús, Luque-Moreno Carlos,
Abstract
Diabetic peripheral neuropathy (DPN) is the primary complication in patients with diabetes mellitus, characterized by loss of sensation and function in the lower limbs. Virtual reality (VR) and/or sensory feedback (FB) therapy has shown positive effects in other neurologic conditions such as stroke. However, consensus regarding their effectiveness in the DPN population is lacking. This study aims to analyze existing scientific evidence about the effects of VR and/or FB on improving gait and balance and reducing the risk of falls in patients with DPN (pwDPN). A thorough search was conducted in scientific databases including PubMed, Scopus, and EMBASE, up until November 2023. CMSQ, the PEDro scale, and the Cochrane Collaboration's tool were used to assess the methodological quality and risk of bias of the studies. A total of 10 studies were selected for qualitative analysis, with three contributing information to the meta-analysis. The combined results suggest a positive trend in favor of VR and FB rehabilitation; however, significant differences were not observed in balance (SMD = -0.81, 95% CI = -1.90, 0.29; = 0.15; I = 86%) or gait speed improvements (MD = -1.05, 95% CI = -2.96, 0.85; = 0.28; I = 89%). Therefore, further randomized controlled studies are still needed to achieve stronger conclusions regarding the benefits of VR and/or FB in pwDPN.
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Effects of cardiorespiratory rehabilitation program on submaximal exercise in patients with long-COVID-19 conditions: a systematic review of randomized controlled trials and recommendations for future studies.
Expert Rev Respir Med2023 Dec;():. doi: 10.1080/17476348.2023.2293226.
Ghram Amine, Latiri Imed, Methnani Jabeur, Souissi Amine, Benzarti Wafa, Toulgui Emna, Ben Saad Helmi,
Abstract
INTRODUCTION:
. Long-COVID-19 patients (LC19Ps) often experience cardiovascular and respiratory complications. Cardiorespiratory rehabilitation programs (CRRPs) have emerged as promising interventions to enhance exercise capacity in this population. This systematic review aimed to assess the impact of CRRPs on submaximal exercise performance, specifically the 6-minute walk test (6MWT) outcomes, in LC19Ps through an analysis of available randomized controlled trials (RCTs).
METHODS:
A systematic search was conducted in and to identify relevant RCTs. Six RCTs meeting inclusion criteria were included in this review, investigating the effects of CRRPs on 6MWT outcomes in LC19Ps.
RESULTS:
The findings from the included RCTs provide compelling evidence supporting the effectiveness of CRRPs in improving submaximal exercise performance in LC19Ps. These results underscore the potential of CRRPs to enhance submaximal exercise capacity and overall functional well-being in this population. However, future research is imperative to determine optimal CRRPs, including duration, intensity, and specific intervention components. Additionally, the long-term sustainability and durability of CRRP-induced improvements warrant further exploration. Future studies should prioritize patient-centric outcomes and address potential implementation barriers.
CONCLUSION:
CRRPs show promise in ameliorating submaximal exercise performance among LC19Ps. Further research is needed to refine these programs and ensure their lasting impact on this patient group.
SYSTEMATIC REVIEW REGISTRATION:
: https://doi.org/10.17605/OSF.IO/HMN38.
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The Role of Serum Monocytes and Tissue Macrophages in Driving Left Ventricular Systolic Dysfunction and Cardiac Inflammation Following Subarachnoid Hemorrhage.
Neurocrit Care2023 Dec;():. doi: 10.1007/s12028-023-01891-2.
Geraghty Joseph R, Saini Neil S, Deshpande Ashwini, Cheng Tiffany, Nazir Noreen, Testai Fernando D,
Abstract
BACKGROUND:
Neurocardiogenic injury is common after aneurysmal subarachnoid hemorrhage (aSAH) despite low prevalence of preexisting cardiac disease. Potential mechanisms include autonomic dysregulation due to excess catecholamines as well as systemic inflammation. Understanding how inflammation contributes to cardiac dysfunction may aid in identifying novel therapeutic strategies. Here, we investigated serum leukocytes as predictors of left ventricular systolic dysfunction in patients with aSAH. We also investigated increased cardiac macrophages in an animal model of SAH and whether immunomodulatory treatment could attenuate this inflammatory response.
METHODS:
We retrospectively analyzed 256 patients with aSAH admitted to University of Illinois Hospital between 2013 and 2019. Our inclusion criteria included patients with aSAH receiving an echocardiogram within 72 h of admission. Our primary outcome was echocardiographic evidence of systolic dysfunction. We performed multinomial regression and receiver operating curve analysis. We also used the endovascular perforation model of SAH in male Sprague-Dawley rats to assess for myocardial inflammation. Two days after surgery, hearts were collected and stained for the macrophage marker Iba-1. We compared the presence and morphology of macrophages in cardiac tissue isolated from SAH animals and sham controls treated with and without the immunomodulatory agent fingolimod.
RESULTS:
Of 256 patients with aSAH, 233 (91.0%) underwent echocardiography within 72 h of admission. Of 233, 81 (34.7%) had systolic dysfunction. Patients had baseline differences in the presence of hypertension, alcohol use, and admission Glasgow Coma Scale and Hunt-Hess score. On multivariable analysis, total leukocytes (odds ratio 1.312, p?0.001), neutrophils (odds ratio 1.242, p?=?0.012), and monocytes (odds ratio 6.112, p?=?0.008) were independent predictors of reduced systolic function, whereas only monocytes (odds ratio 28.014, p?=?0.030) predicted hyperdynamic function. Within the rodent heart, there were increased macrophages after SAH relative to controls, and this was attenuated by fingolimod treatment (p?0.0001).
CONCLUSIONS:
Increased serum leukocytes are associated with abnormal left ventricular systolic function following aSAH. The strongest independent predictor of both reduced and hyperdynamic systolic function was increased monocytes. Increased cardiac macrophages after experimental SAH can also be targeted by using immunomodulatory drugs.
© 2023. Springer Science+Business Media, LLC, part of Springer Nature and Neurocritical Care Society.
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Is early initiated cardiorespiratory fitness training within a model of stroke-integrated cardiac rehabilitation safe and feasible?
J Stroke Cerebrovasc Dis2023 Dec;33(2):107493. doi: 10.1016/j.jstrokecerebrovasdis.2023.107493.
Machado Natasha, Williams Gavin, Olver John, Johnson Liam,
Abstract
OBJECTIVE:
To investigate the safety and feasibility of an early initiated stroke-integrated Cardiac Rehabilitation program.
METHODS:
People with acute first or recurrent ischaemic stroke, admitted to Epworth HealthCare were screened for eligibility and invited to participate. In addition to usual care neurorehabilitation, participants performed 1) cardiorespiratory fitness training 3-days/week during inpatient rehabilitation (Phase 1), and/or 2) 2-days/week centre-based cardiorespiratory fitness training plus education and 1-day/week home-based cardiorespiratory fitness training for 6-weeks during outpatient rehabilitation (Phase 2). Safety was determined by the number of adverse and serious adverse events. Feasibility was determined by participant recruitment, retention, and attendance rates, adherence to exercise recommendations, and participant satisfaction.
RESULTS:
There were no study-related adverse or serious adverse events. Of 117 eligible stroke admissions, 62 (53%) were recruited, while 10 (16.1%) participants withdrew. Participants attended 189 of 201 (94%) scheduled cardiorespiratory fitness training sessions in Phase 1 and 341/381 (89.5%) scheduled sessions in Phase 2. Only 220/381 (58%) scheduled education sessions were attended. The minimum recommended cardiorespiratory fitness training intensity (40% heart rate reserve) and duration (20 minutes) was achieved by 57% and 55% of participants respectively during Phase 1, and 60% and 92% respectively during Phase 2. All respondents strongly agreed (69%) or agreed (31%) they would recommend the stroke-integrated Cardiac Rehabilitation program to other people with stroke.
CONCLUSION:
Cardiorespiratory fitness training in line with multiple clinical practice guidelines included within a model of stroke-integrated Cardiac Rehabilitation appears to be safe and feasible in the early subacute phase post-stroke.
Copyright © 2023 Elsevier Inc. All rights reserved.
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Evaluation of an application for the self-assessment of lifestyle behaviour in cardiac patients.
Neth Heart J2023 Dec;():. doi: 10.1007/s12471-023-01835-7.
Goevaerts Wilhelmina F, Tenbült-van Limpt Nicole C C W, Lu Yuan, Kop Willem J, Kemps Hareld M C, Brouwers Rutger W M,
Abstract
BACKGROUND:
Currently, no uniform, well-validated and comprehensive lifestyle behaviour self-assessment instrument exists for patients with cardiovascular disease.
PURPOSE:
To evaluate the usability of a novel mobile application (LifeStyleScore) based on validated instruments for the assessment of cardiovascular risk behaviours. Secondly, the application's acceptance by healthcare professionals (HCPs) and its association with improved patient activation and lifestyle behaviour was evaluated.
METHODS:
In this single-centre, non-randomised observational pilot study, patients with coronary artery disease or atrial fibrillation entering cardiac rehabilitation (CR) completed the LifeStyleScore application, the Patient Activation Measure (PAM-13®), and the System Usability Scale (SUS) during the CR intake and after CR completion. A focus group interview was performed with the HCPs involved.
RESULTS:
We analysed 20 participants, 3 of whom were women, with a mean age of 61.9?±?6.7 years. The LifeStyleScore application was rated with a SUS score above average (>?68) before (69.6?±?13.4) and after CR (68.6?±?15.1). All HCPs (n?=?8) found the application usable. Patient activation did not increase significantly after CR compared with baseline (62.0?±?8.6 versus 59.2?±?9.5, respectively, p?=?0.28) and only physical activity levels improved significantly (2.4?±?0.7 (standardised score) at baseline, 2.8?±?0.4 after CR, p?=?0.04).
CONCLUSION:
The LifeStyleScore application was found to be usable for patients receiving CR. Its use did not result in increased patient activation, and of the lifestyle behaviours only physical activity levels improved. Further research is needed to evaluate how such applications can be optimally incorporated in CR programmes.
© 2023. The Author(s).
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2021 European Resuscitation Council/European Society of Intensive Care Medicine Algorithm for Prognostication of Poor Neurological Outcome After Cardiac Arrest-Can Entry Criteria Be Broadened?
Crit Care Med2023 Dec;():. doi: 10.1097/CCM.0000000000006113.
Arctaedius Isabelle, Levin Helena, Larsson Melker, Friberg Hans, Cronberg Tobias, Nielsen Niklas, Moseby-Knappe Marion, Lybeck Anna,
Abstract
OBJECTIVES:
To explore broadened entry criteria of the 2021 European Resuscitation Council/European Society of Intensive Care Medicine (ERC/ESICM) algorithm for neuroprognostication including patients with ongoing sedation and Glasgow Coma Scale-Motor score (GCS-M) scores 4-5.
DESIGN:
Retrospective multicenter observational study.
SETTING:
Four ICUs, Skane, Sweden.
PATIENTS:
Postcardiac arrest patients managed at targeted temperature 36°C, 2014-2018. Neurologic outcome was assessed after 2-6 months according to the Cerebral Performance Category scale.
INTERVENTIONS:
None.
MEASUREMENTS AND MAIN RESULTS:
In 794 included patients, median age was 69.5 years (interquartile range, 60.6-77.0 yr), 241 (30.4%) were female, 550 (69.3%) had an out-of-hospital cardiac arrest, and 314 (41.3%) had a shockable rhythm. Four hundred ninety-five patients were dead at follow-up, 330 of 495 died after a decision on withdrawal of life-sustaining therapies. At 72 hours after cardiac arrest 218 patients remained unconscious. The entry criteria of the original algorithm (GCS-M 1-3) was fulfilled by 163 patients and 115 patients with poor outcome were identified, with false positive rate (FPR) of 0% (95% CI, 0-79.4%) and sensitivity of 71.0% (95% CI, 63.6-77.4%). Inclusion of patients with ongoing sedation identified another 13 patients with poor outcome, generating FPR of 0% (95% CI, 0-65.8%) and sensitivity of 69.6% (95% CI, 62.6-75.8%). Inclusion of all unconscious patients (GCS-M 1-5), regardless of sedation, identified one additional patient, generating FPR of 0% (95% CI, 0-22.8) and sensitivity of 62.9% (95% CI, 56.1-69.2). The few patients with true negative prediction (patients with good outcome not fulfilling guideline criteria of a poor outcome) generated wide 95% CI for FPR.
CONCLUSION:
The 2021 ERC/ESICM algorithm for neuroprognostication predicted poor neurologic outcome with a FPR of 0%. Broadening inclusion criteria to include all unconscious patients regardless of ongoing sedation identified an additional small number of patients with poor outcome but did not affect the FPR. Results are limited by high rate of withdrawal of life-sustaining therapies and few patients with true negative prediction.
Copyright © 2023 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.
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Technology-assisted cardiac rehabilitation for coronary heart disease patients with central obesity: a randomized controlled trial.
Eur J Phys Rehabil Med2023 Dec;():. doi: 10.23736/S1973-9087.23.08111-X.
Su Jing-Jing, Wong Arkers-Kwan-Ching, Zhang Li-Ping, Bayuo Jonanthan, Lin Rose S, Abu-Odah Hammoda, Batalik Ladislav,
Abstract
BACKGROUND:
Limited empirical evidence is available regarding the effect of technology-assisted cardiac rehabilitation (TACR) among coronary heart disease (CHD) patients with central obesity.
AIM:
To determine the effects of 12-week TACR on health outcomes of patients with CHD.
DESIGN:
Two-arm randomized controlled trial.
SETTING:
Cardiovascular department of a regional hospital.
POPULATION:
Coronary heart disease patients with central obesity.
METHODS:
The study randomized 78 hospitalized CHD patients to receive either the 12-week TACR intervention or usual care. Guided by social cognitive theory, the intervention began with an in-person assessment and orientation session to assess and identify individual risks and familiarize with the e-platform/device before discharge. After discharge, patients were encouraged to visit the interactive CR website for knowledge and skills acquisition, data uploading, use the pedometer for daily step tracking, and interact with peers and professionals via social media for problem-solving and mutual support. Data were collected at baseline (T0), six-week (T1), and 12-week (T2).
RESULTS:
Participants in the intervention group showed significant improvement in daily steps at six weeks but not 12 weeks (T1: ?=2713.48, P=0.03; T2:?=2450.70, P=0.08), weekly sitting minutes (T1: ?=-665.17, P=0.002; T2: ?=-722.29, P=0.02), and total (vigorous, moderate, and walking) exercise at 12-week (?=-2445.99, P=0.008). Improvement in health-promoting lifestyle profile (T1: ?=24.9, P
CONCLUSIONS:
Results indicated the effectiveness of the TACR intervention in improving healthy behaviors and anthropometric parameters for CHD patients with central obesity. Individual assessment, collaborative action planning, and ongoing obesity management support should be highlighted in TACR programs for CHD patients.
CLINICAL REHABILITATION IMPACT:
Central obesity should be assessed and highlighted in TACR intervention as an independent risk factor that requires corresponding behavior change and body fat management.
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European Society of Cardiology Core Curriculum for Cardio-Oncology.
Eur J Heart Fail2023 Dec;():. doi: 10.1002/ejhf.3102.
López-Fernández Teresa, Farmakis Dimitrios, Ameri Pietro, Asteggiano Riccardo, de Azambuja Evandro, Aznar Marianne, Barac Ana, Bayes-Genis Antoni, Bax Jeroen J, Bergler-Klein Jutta, Boriani Giuseppe, Celutkiene Jelena, Coats Andrew, Cohen-Solal Alain, Córdoba Raúl, Cosyns Bernard, Filippatos Gerasimos, Fox Kevin, Gulati Geeta, Inciardi Riccardo M, Lee Geraldine, Mamas Mamas A, Novo Giuseppina, Plummer Chris, Psyrri Amanda, Rakisheva Amina, Suter Thomas, Tini Giacomo, Tocchetti Carlo Gabriele, Toutouzas Konstantinos, Wilhelm Matthias, Metra Marco, Lyon Alexander R, Rosano Giuseppe M C,
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Cardiac Timeless Trans-Organically Regulated by miR-276 in Adipose Tissue Modulates Cardiac Function.
Function (Oxf)2024 ;5(1):zqad064. doi: zqad064.
Tang Chao, Li Qiufang, Wang Xiaoya, Yu Zhengwen, Ping Xu, Qin Yi, Liu Yang, Zheng Lan,
Abstract
The interconnection between cardiac function and circadian rhythms is of great importance. While the role of the biological clock gene Timeless (Tim) in circadian rhythm has been extensively studied, its impact on cardiac function remains largely been unexplored. Previous research has provided experimental evidence for the regulation of the heart by adipose tissue and the targeting of miR-276a/b on Timeless. However, the extent to which adipose tissue regulates cardiac Timeless genes trans-organically through miR-276a/b, and subsequently affects cardiac function, remains uncertain. Therefore, the objective of this study was to investigate the potential trans-organ modulation of the Timeless gene in the heart by adipose tissue through miR-276a/b. We found that cardiac-specific Timeless knockdown and overexpression resulted in a significant increase in heart rate (HR) and a significant decrease in Heart period (HP), diastolic intervals (DI), systolic intervals (SI), diastolic diameter (DD), and systolic diameter (SD). miR-276b systemic knockdown resulted in a significant increase in DI, arrhythmia index (AI), and fractional shortening (FS) significantly increased and SI, DD and SD significantly decreased. Adipose tissue-specific miR-276a/b knockdown and miR-276a overexpression resulted in a significant increase in HR and a significant decrease in DI and SI, which were improved by exercise intervention. This study presents a novel finding that highlights the significance of the heart circadian clock gene Timeless in heart function. Additionally, it demonstrates that adipose tissue exerts trans-organ modulation on the expression of the heart Timeless gene via miR-276a/b.
© The Author(s) 2023. Published by Oxford University Press on behalf of American Physiological Society.
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The State of Cardiac Rehabilitation in Saudi Arabia: Barriers, Facilitators, and Policy Implications.
Cureus2023 Nov;15(11):e48279. doi: e48279.
Adam Tasneem, Al Sharif Abdullah I, Alamri Taghreed Saeed M, Al-Nashri Rawan Ahmad O, Alluwimi Alaa Ibrahim M, Samkri Amani Yosef, Alharthi Mohammed Abdullah, Moafa Ahmed Yahya, Alsaadi Nawaf A, Alraimi Abdullah Mahdi S, Alquzi Reham Hassan M,
Abstract
Cardiovascular disease (CVD) is a critical public health issue in Saudi Arabia, where it is the leading cause of death. The economic burden of CVD in the country is expected to triple by 2035, reaching $9.8 billion. This paper provides an overview of CVD in Saudi Arabia and its risk factors, impact on healthcare, and effects on patients' quality of life. The review emphasizes the potential of cardiac rehabilitation (CR) programs in addressing the CVD epidemic. CR programs have been shown to reduce morbidity, mortality, and hospital readmissions while improving patients' cardiovascular health and overall well-being. However, these programs are underutilized and inaccessible in Saudi Arabia. The paper highlights the urgent need for CR programs in the country and suggests key strategies for implementation. These include increasing patient referrals, tailoring programs to individual needs, enhancing patient education, and making CR accessible through home-based options. Fostering multidisciplinary collaboration and developing tailored guidelines for Arab countries can further enhance the impact of CR programs. In conclusion, this review underscores the vital importance of comprehensive CR programs in Saudi Arabia to combat the rising CVD burden, improve patient quality of life, and align with the goals of the Saudi 2030 Vision for a healthier society.
Copyright © 2023, Adam et al.
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The effect of cardiac rehabilitation on cardiopulmonary function after coronary artery bypass grafting: A systematic review and meta-analysis.
iScience2023 Dec;26(12):107861. doi: 107861.
Miao Jiapeng, Yang Huayun, Shi Ruizheng, Wang Chengming,
Abstract
We carried out a meta-analysis on the effect of cardiac rehabilitation (CR) on cardiopulmonary function after coronary artery bypass grafting (CABG). Four databases were searched for studies comparing CR with control. A random-effects model was used to pool mean difference (MD). The meta-analysis showed an increase in peak oxygen consumption (peak VO) (MD = 1.93 mL/kg/min, p = 0.0006), and 6-min walk distance (6MWD) (MD = 59.21 m, p
© 2023 The Author(s).
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