Cardiac Rehabilitation Unit Research Articles

Comparison of SF-36 and RAND-36 in Cardiovascular Diseases: A Reliability Study

Background/Objectives: Cardiovascular diseases are one of the leading causes of morbidity and mortality worldwide. Health-related quality of life is crucial to assess the impact of cardiovascular diseases and to guide therapeutic strategies. The Short Form 36 Health Survey and the RAND 36-Item Health Survey questionnaires are common tools for measuring health-related quality of life in patients with cardiovascular disease, but their reliability may vary according to the population studied. The aim of this study is to compare the reliability of the SF-36 and the RAND-36 in a population with cardiac pathology, addressing the question of which of these instruments offers a more consistent and useful measurement in this specific group. Methods: A cross-sectional observational study was carried out at the University Hospital of Burgos (Spain). A total of 413 patients with cardiovascular pathology referred to the Cardiac Rehabilitation Unit were included. Patients with incomplete data or who did not participate in the program were excluded. Internal consistency (Cronbach’s alpha), item–total correlation and reliability, and a half-and-half analysis were performed. Results: Both questionnaires showed similar and adequate reliability for patients with cardiovascular pathology. Internal consistency, as measured with Cronbach’s alpha, was above 0.80 for most dimensions, supporting its robustness. Significant inter-item and inter-dimension correlations were found in both scales, except in some specific cases in the dimension ‘Physical Functioning’. The half-and-half analysis confirmed the good reliability of both scales. Conclusions: Both the SF-36 and the RAND-36 are highly reliable tools for assessing health-related quality of life in patients with cardiovascular disease. The results may have significant implications for clinical practice, helping in the selection of health-related quality of life monitoring instruments and in the evaluation of the efficacy of therapeutic interventions.

Effect of cardiac rehabilitation on heart rate recovery in patients with coronary artery disease

Background/Aim: It is well-established that individuals with coronary artery disease (CAD) often exhibit autonomic dysfunction and a reduction in vagal function is associated with increased mortality and morbidity. Vagally mediated heart rate recovery (HRR) can be assessed by analyzing the post-exercise heart rate (HR) decay. It is hypothesized that effective exercise-based cardiac rehabilitation (CR) can enhance post-exercise parasympathetic function. This study aims to evaluate the impact of CR on HRR and other cardiac parameters in CAD patients. Methods: This retrospective cohort study was conducted at a single center. It included patients with CAD who were referred to the CR unit and completed either 30 or 60 sessions. These patients were free from angina or angina-equivalent symptoms at the time of enrollment and were receiving guideline-directed medical therapy for ischemic heart disease. A customized CR program was implemented for each patient. To calculate HRR, the maximum HR during the exercise test and HR values at 1, 2, and 3 minutes after exercise cessation were recorded. The differences between the maximum HR and the HR values at the end of the 1st, 2nd, and 3rd minutes after exercise were designated as HRR1, HRR2, and HRR3, respectively. Results: This study enrolled 104 patients with CAD. Following CR, there was a significant improvement in functional capacity, as assessed by the 6-minute walk test (from 367.83 [56.58] to 381.61 [53.76], P=0.001), and endurance, as measured by the Cycle Ergometer Test Maximum Watts (from 63.22 [22.29] to 77.38 [19.87], P<0.001). CR also led to a noteworthy increase in HRR1, HRR2, and HRR3 (P=0.036, P=0.015, P=0.002, respectively). Conclusion: In our study, both the functional capacity and endurance of CAD patients improved significantly after CR sessions. Additionally, HRR showed a substantial increase following CR, suggesting that exercise-based CR can enhance post-exercise parasympathetic function. HRR may serve as a potential prognostic marker for predicting outcomes in CR.

The Spanish adaptation of the Tampa Scale for Kinesiophobia Heart: psychometric evidence in cardiac rehabilitation patients.

The factor structure of the Tampa Scale of Kinesiophobia Heart version has rarely been adequately analyzed. We aimed to evaluate the psychometric properties of this scale through a variety of exploratory and confirmatory factorial approaches. To perform a translation, cross-cultural adaptation, and psychometric evaluation of the Spanish version of the Tampa Scale of Kinesiophobia Heart in patients attending Cardiac Rehabilitation (TSK-SPA). Cross-sectional study. A Cardiac Rehabilitation unit. Adults with the principal diagnosis of coronary artery disease (83%) who were referred to Cardiac Rehabilitation (N.=194; mean age, 64.28±9.2; 15% women). We performed a translation and a cross-cultural adaptation of the TSK-SPA. The psychometric properties of validity comprising the face, content, and construct validity were then tested. Five factorial models were proposed to analyze the data structure. We examined the validity evidence of the TSK-SPA based on the relationships with other analyzed variables using the SF12 quality of life Questionnaire, the International Physical Activity Questionnaire, the Hospital Anxiety and Depression Scale and the Beck Depression Inventory. The reliability tests included internal consistency and stability over time. The results suggested a four-dimensional structure. Models with more than 1 dimension exhibited undesirable factor loadings or inadequate fit indices. Based on these results, a short version of the scale with 13 items is proposed. In terms of reliability, the TSK-SPA Heart was found internally consistent (α=0.79) and stable over time (test-retest = 0.82). An Exploratory Structural Equation Modeling (ESEM) analysis provided an acceptable fit for a hypothesized 4-factor model with the inclusion of a method factor: the root mean squared error of approximation was <0.05 (RMSEA = 0.046), and the comparative fit indices were >0.95 or close (CFI=0.994, TLI=0.934). Significant positive correlations were observed between the TSK-SPA scores and the measures of anxiety and depression, with correlation coefficients ranging from 0.35 to 0.48. A best-fitting model was identified, and the proposed 13-item TSK-SPA Heart showed sufficient evidence of validity and reliability for Spanish patients with cardiovascular disease. The scale's overall reliability is deemed acceptable, although the factor reliability could be further enhanced. Using this questionnaire on fear or avoidance of movement will improve our understanding of cognitive-behavioral factors in patients with cardiovascular disease, aiding their rehabilitation and optimizing their prognosis.

Effect of exercise based cardiac rehabilitation on LV systolic function &amp; exercise stress parameters in patients with ischemic cardiomyopathy post anterior STEMI

Background: Cardiovascular diseases are a leading cause of death worldwide. Multiple meta-analysis have demonstrated the benefit of exercise based cardiac rehabilitation. However, the effect of exercise training on left ventricular (LV) systolic function in patients with ischemic cardiomyopathy has been controversial in the literature. Objective: To study the effect of exercise-based cardiac rehabilitation (EBCR) on left ventricular (LV) systolic function and exercise stress parameters (METs achieved, HR recovery and HR reserve) in post anterior STEMI patients with ischemic cardiomyopathy (EF≤45%). Patients and methods: The study included 50 patients with ischemic cardiomyopathy (Post anterior STEMI successfully treated by 1ry PCI) referred for cardiac rehabilitation unit at Ain Shams University Hospitals. The patients were subjected to 3 months of formal exercise based cardiac rehabilitation. Before the CR program, they were subjected to a symptom-limited exercise test (modified Bruce protocol) to exclude any remaining ischemia and calculate enrolment HR reserve, baseline heart rate recovery in 1st minute and 2nd minute (HRR1 and HRR2). Another symptom-limited exercise test was done post CR program to assess the forementioned exercise parameters after completion of the program. Echocardiography was done at baseline and after completion of the CR program for assessment of LV systolic function by ejection fraction (assessed by 2D Simpson’s method) and peak longitudinal strain of the left ventricle (measured using speckle tracking echocardiography). Results: Exercise-based cardiac rehabilitation was associated with significant improvement in LV systolic function as reflected by significant improvement in Global longitudinal strain (GLS) (P-value = 0.0001) in patients with ischemic heart failure. CR was also associated with improvement in the functional capacity as reflected by the improvement in METs as well as in the HRR and HR reserve (P-value = 0.0001). However, there was no significant change regarding EF before and after cardiac rehabilitation (P-value= 0.4582).

Effects of a brief intervention based on Acceptance and Commitment Therapy versus usual care for cardiac rehabilitation patients with coronary heart disease (ACTonHEART): a randomised controlled trial

ObjectivesThe main objective of the study is to investigate the short-term efficacy of Acceptance and Commitment Therapy (ACT) on the simultaneous modification of biological indicators of risk and psychological well-being...

The psychological well-being index and quality of life after a cardiac rehabilitation program based on aerobic training and psychosocial support

BackgroundThis study aimed to investigate the physical and psychological benefits of an alternative cardiac rehabilitation program based on therapeutic groups during physical exercise sessions and to compare the results with those of a conventional cardiac rehabilitation program. MethodThe sample included 112 patients from the cardiac rehabilitation unit of a medical center, 91.1 % of whom were male. The control group consisted of 47 subjects, with a mean age of 57.89 ± 12.30 and the experimental group consisted of 65 subjects, with a mean age of M = 58.38 ± 9.86. Quality of life, psychological well-being, health-related quality of life, body mass index, blood pressure, abdominal circumference and resting heart rate were measured before starting and at the end of the cardiac rehabilitation program. ResultsThe experimental group improved significantly more than the control group in body mass index, systolic and diastolic blood pressure, abdominal circumference, and resting heart rate (p value < 0.005). In addition, the experimental group had significantly greater improvements in quality of life, psychological well-being, and health-related quality of life than the control group (p-value < 0.001). ConclusionsA cardiac rehabilitation program based on simultaneous aerobic training and psychosocial support improved the physical function, health-related quality of life and well-being.

Home- versus clinic-based exercise intervention in patients with heart failure (EXIT-HF trial): a pragmatic randomized controlled trial

Abstract Background The limited accessibility partially explains the low uptake of cardiac rehabilitation (ExCR) for heart failure (HF). Home-based programs might address those obstacles but few data from randomized trials are available. Purpose To compare the effectiveness of a home-based versus clinic-based ExCR intervention in HF patients. Methods Single-center, single-blind, parallel groups, non-inferiority pragmatic randomized control trial (1:1 and after COVID-19 2:1 home- vs clinic-based). Adult HF patients referred to our cardiac rehabilitation (CR) unit were randomized to either a clinic-based (24 supervised sessions at a CR unit of a tertiary hospital over 12 weeks) or home-based (4 supervised ExT sessions to familiarize with the training protocol and the remaining sessions continued at home) over 12 weeks. Exercise training protocol consisted of a combination of endurance (at 60%-80% of peak oxygen uptake [VO2peak] and resistance training (elastic bands). The primary endpoint was the change in VO2peak at the end of the 12-week program. Secondary outcomes included adherence (&amp;gt;80% of sessions attendance) and change of Minnesota Living with HF Questionnaire (MLHFQ) scores. Results 120 patients (mean age 64±11 years; 64% men) were randomized: 44 to clinic- and to 76 home-based intervention. 41% had an ischemic cardiomyopathy, 27% had an ICD/CRT, the mean LVEF was 36±11% (62% had LVEF &amp;lt;40%), 73% were on NYHA class II, and the median NT-proBNP was 361 [IQR 170-1008] ng/mL. Intervention groups were well balanced, including basal VO2peak that was similar between groups (17.8±4.8 vs 18.1±5.2 mL/min/Kg; p=0.75). Adherence was similar between groups (87.5% vs 82.5%; p=0.50). At week 12, on average, patients increased VO2 peak by 0.9±2.5 mL/min/Kg compared to baseline (p&amp;lt;0.001). No significant differences were found between clinic- and home-based interventions (p=0.25). Consistently, the MLHFQ total score decreased significantly overall (-10.3±1.7 points; p&amp;lt;0.001), with no significant differences between groups (p=0.91). The drop-out rate was 14% and 17% in clinic- and home-based groups, respectively. Conclusions The clinical impact of home-based CR program on peakVO2 and health-related quality of life of HF patients was similar to a standard supervised clinic-based one. Our data support the home-based program as an effective alternative way of delivering CR in HF.

Assessment of Left Atrial Function in Ischemic Heart Patients before and after Cardiac Rehabilitation Using Speckle Tracking Echocardiography

Abstract Background Coronary heart disease (CHD) is one of the most common forms of heart disease. It affects the heart by restricting or blocking the flow of blood around it. This can lead to anginal pain or myocardial infarction. Exercisebased cardiac rehabilitation aims to restore people with CHD to health through combination of exercise with education and psychological support. Aim of the Work to evaluate left atrial function in ischemic patients before and after cardiac rehabilitation using speckles tracking. Patients and Methods The study included 60 individuals who were recruited from Ain Shams University hospital. All patients were recruited from the cardiac rehabilitation unit. These patients had recent MI that was successfully revascularized one month before inclusion. They were recruited in the period between December 2019, and complete in December 2020, Echocardiography (including 2D STE for assessment of LA function) was performed at baseline, and after a 3-month follow-up for all patients. Results This result reveal that CR could improve LV global and regional function and should be used routinely as a part of management of patient after acute myocardial infarction, also LA function improved Regarding LA diameter (considered as the standard single plane dimension of left atrium) dropped from 36.93 ± 4.60 mm to 33.85 ± 4.86 after CR showing highly significant change, Left atrial volume index (LAVI) dropped from 20.63 ± 8.05 mL/m2 to 17.40 ± 6.37, after CR, Showing highly significant changes, Peak atrial longitudinal strain mean value and systolic strain rate median, both improved significantly (p &amp;lt; 0.001) after cardiac rehabilitation, with the former increasing from 15.21 ± 5.49 cm/s to 20.69 ± 8.13 cm/s and the latter increasing from 0.4 (0.25 ‒ 0.75)s-1 to 0.65 (0.5 ‒ 1.1) s-1. after CR. Conclusion Speckle tracking imaging of left atrium has proved to be a feasible and reproducible tool for the assessment of left atrial mechanics. With significant improvement in left atrial function after 3 months of exercise training CR program.

Correlation between Heart Rate Recovery &amp; Global Longitudinal Strain in Heart Failure Patients Subjected to Cardiac Rehabilitation

Abstract Background Cardiac rehabilitation is a medically supervised program designed to improve cardiovascular outcomes after MI, heart failure, angioplasty, or heart surgery. It is a complex intervention that involves a variety of therapies, including supervised exercise training, health education and risk factor modification, behavior change, social and psychological support. Objective To study the correlation between heart rate recovery &amp; global longitudinal strain in heart failure patients subjected to cardiac rehabilitation. Patients and Methods This study was conducted in the cardiac rehabilitation (CR) unit in the cardiology department of Ain Shams University hospital between December 2019 and December 2020 to investigate the correlation between heart rate recovery &amp; global longitudinal strain in heart failure patients subjected to cardiac rehabilitation. Results Our study is the first study that investigated the correlation between HRR and GLS in ischemic heart failure patients subjected to cardiac rehabilitation. Conclusion Exercise-based cardiac rehabilitation leads to improvement in the functional capacity of ischemic heart failure patients as reflected by the improvement in HRR and also leads to IMPROVEMENT in LV functions as reflected by the improvement in GLS. Moreover, METs and HR reserve was improved significantly with CR.

Discordance between LDL cholesterol and apolypoprotein B. Which to prefer to guide treatment?

Abstract Funding Acknowledgements Type of funding sources: None. Current cardiovascular risk guidelines recommend target values of low-density lipoprotein cholesterol (LDLc) &amp;lt; 55 mg/dL and apolipoprotein B (apoB) &amp;lt; 65 mg/dL. However, they don’t clarify what the attitude should be when one of the two targets is not achieved. Our objective was to establish the prevalence of LDLc and ApoB discordance in a secondary prevention population in our cardiac rehabilitation unit and describe the size of LDLc particles in this cohort of patients. We conducted a retrospective observational study including patients with previous ischemic heart disease with lipid-lowering treatment in secondary prevention followed up in our cardiac rehabilitation unit between February 2022 and September 2022. We present a series of 100 patients with a mean age of 60.5 years (S.D. 9.7), 79% male, with high prevalence of cardiovascular risk factors (59% hypertension, 26% diabetes mellitus, 52% smokers). All patients received lipid-lowering therapies, with statins alone or in combination with Ezetimibe. 30 patients (30%) had LDLc &amp;gt; 55 mg/dL and ApoB &amp;lt; 65 mg/dL, 37 (37%) reached target LDL and ApoB levels (LDLc &amp;lt; 55 mg/dL and ApoB &amp;lt; 65 mg/dL), and 33 (33%) did not reach any of the target levels (LDLc &amp;gt; 55mg/dL and ApoB &amp;gt; 65 mg/dL). No patient had LDLc &amp;lt; 55mg/dL and ApoB &amp;gt; 65mg/dL. Among patients with ApoB target level achieved and LDLc &amp;gt; 55mg/dL, the mean LDLc/ApoB ratio was 1.1 (S.D. 0.1). The mean ratios stratified by LDLc level are represented in Figure 1 and specified in Table 1. The conclusion of our study is that in clinical practice we find a group of patients with discrepancy between LDLc and ApoB levels that is not represented in the main studies of cardiovascular outcomes. Therefore, we do not know what therapeutic approach we should take. It is known that these relatively high LDLc values when apoB is in range correspond to larger and less dense particles, and therefore less atherogenic, and it has been suggested that ApoB levels better reflect residual risk than LDLc in statin-treated patients. At this point, the question that arises is: should we take these patients to an LDL &amp;lt; 55mg/dL or is their lipid risk controlled?

Cardiac rehabilitation in women. Have we improved care in recent years?

Abstract Funding Acknowledgements Type of funding sources: None. Main funding source(s): Ninguna. Introduction Cardiovascular disease is the main cause of morbidity and mortality worldwide, but there are inequalities in diagnosis and treatment between men and women. Although there is greater awareness of cardiovascular disease in women, diagnostic techniques are less used in women, they receive fewer pharmacological and invasive treatments, and have less access to cardiac rehabilitation. Objective To compare the assistance offered to men and women in our Cardiac Rehabilitation Unit up to 2018 with the assistance given from 2019 to 2022. Methods Patients treated in the Cardiac Rehabilitation Unit before 2018 (group 1) and from 2019 to 2022 (group 2) were analyzed, comparing the characteristics of male and female patients, as well as the attendance rate to Cardiac Rehabilitation and treatments indicated. Results In group 1, we analyzed the data of 399 patients, 19.8% women. In group 2, which included 167 patients, the rate of women rose to 26.3%, this difference being statistically significant (p&amp;lt;0. 05). Women were older than men in both groups (63 vs 59 years in group 1; 64 vs 59 years in group 2), less smokers (26.3% vs 57.3% in group 1; 25% vs 50.4% in group 2). The percentage of hypertensive patients was the same in both sexes in group 2. Until 2018, fewer coronary angiographies were performed on women (94% vs 99%, p&amp;lt;0.05); however, in the second period (group 2, 2019-2022), the percentage was similar in both sexes, (96% vs 98%, p= n.s.). Revascularization is less, possibly due to the characteristics of coronary disease in women (Table 1). Lipid-lowering treatments are used equally in both groups (Table 1). Conclusion In recent years, care for cardiovascular disease in women has been improving. The percentage of women who are included in Cardiac Rehabilitation program and who undergo coronary angiography has increased. The raising awareness that this disease has the same severity in both sexes has allowed the optimal medical treatment implemented to be similar.

Cardiac rehabilitation in the Comprehensive Cardiac Care program in the time of a COVID – 19 pandemic

Introduction and purpose: Cardiac rehabilitation in patients after myocardial infarction is an established form of therapy. Its main tasks in the context of the implementation of the KOS program are to improve quality of life, consolidate the effects of hospital treatment and ensure better functioning after a cardiovascular incident. The purpose of this paper is to analyze the current level of knowledge regarding cardiac rehabilitation of patients during the COVID-19 pandemic.&#x0D; Description of the state of knowledge: COVID-19 poses a significant threat to patients with cardiovascular disease. Physiotherapy in the Cardiac Rehabilitation Unit involves a step-by-step, individualized rehabilitation plan in accordance with the patient's condition. An important tool for clinical evaluation is capacity tests, the results of which provide key information for the rehabilitation team in selecting exercise intensity. These tests are performed on the first and last days of rehabilitation. In Polish conditions, the most common tests examining capacity are an exercise test on a treadmill or bicycle cycler or a 6-minute walk test. Due to the diversion of a significant number of specialists and health care teams to treat COVID - 19 patients, access to the possibility of implementing the various stages of the Coordinated Specialized Care program after myocardial infarction has been limited.&#x0D; Summary: Post-infection patients are often forced to live a sparing lifestyle. They show reduced exercise tolerance and easier fatigability. With these aspects in mind, improving the quality of life of patients after cardiovascular incidents in the era of the pandemic requires even greater involvement of the entire rehabilitation team.

P124 A TAKOTSUBO SYNDROME MIMICKING AN APICAL HYPERTROPHIC CARDYOMYOPATHY: A CASE REPORT

Abstract A 70–year–old woman was admitted to our Intensive Care Unit (ICU) with high levels Hs–TnT. Coronaries were normal and ventriculography was suggestive for Takotsubo Syndrome (TS). In the acute phase she developed a cardiogenic shock and transthoracic echocardiography (TTE) showed a dilated left ventricle (LV) with iperkinesia of basal segments and biventricular apex and mid –ventricular akinesia, with a severely reduced left ventricular ejection fraction (LVEF 20%). Seven days after admission to Cardiac Rehabilitation Unit, a TTE showed LV apical hypertrophy (max thickness 18 mm), hypokinesia of hypertrophic segments, hypercontractility of basal segments and LVEF 55%. These features could have been suggestive for a coexisting apical hypertrophic cardiomyopathy (HCM). The EKG showed T wave inversions in precordial and inferior leads, not present at admission, this observation being against the presence of a pre–existing unknown HCM. Cardiac Magnetic Resonance (CMR) showed T1 and T2 mapping imagines for oedema in LV infero–lateral, basal segments and apical region, a subepicardial stria of late gadolinium enhancement in infero–lateral basal segment. These patterns were reported as suggestive for myocarditis rather than TS. Recent infectious or autoimmune diseases were excluded. Further TTE showed reversed LV parameters, normal kinesis of all segments, LVEF 66%, with a persistence of negative T waves at EKG. Discussion Our patient developed a classical TS with LV apical ballooning and hyperkinesia of basal segments with uncommon right ventricular hypokinesia. A peculiar finding was the transient apical LV thickness that was seen through TTE, mimicking an apical hypertrophic cardiomyopathy. Such a finding has already been described in few case reports; however, the nature and the physiopathology of that apical thickness was never proved. Through CMR we noted that, in the same region where TTE detected apical hypertrophy, there was a consistent amount of oedema which could be the reason of pseudo–hypertrophy findings. Our experience confirms the importance of integrating CMR in the diagnostic algorithm as already supported in consensus statements. In our case CMR played a key–role in the exclusion of a coexisting apical hypertrophic cardiomyopathy.

Assessment of patient satisfaction with nursing care with the Newcastle scale

Abstract Introduction. Improving the quality of provided services and increasing patient satisfaction in medical facilities is an undoubted challenge for health care institutions in Poland. A high level of nursing care increases the efficiency of the treatment process, reduces the costs of health care units and affects the patient’s sense of satisfaction and contentment. Aim. The aim of this paper was to assess the level of satisfaction with nursing care using the Newcastle scale. Material and methods. The study included 117 patients hospitalized in the cardiac rehabilitation unit. The research tool used in the study was the standardized Newcastle questionnaire to assess patients’ overall satisfaction and experiences with nursing care at the unit level. Results. The respondents’ experience of nursing care was rated at a medium level, while their level of satisfaction with nursing care was rated at a high level. The above rating was influenced by the age and educational level of the patients. Conclusions. Patients of cardiac rehabilitation units rate the experience of nursing care well, while their level of satisfaction with this care is high.

Adherence to Mediterranean diet among patients with acute cardiovascular events admitted in Cardiac Rehabilitation unit.

The Mediterranean Diet plays a critical role in the prevention of primary cardiovascular disease (CVD). Actually, there is a scarcity of evidence for secondary prevention. The current study aims to assess adherence to the Mediterranean diet (MD) in patients recently admitted to the Cardiac Rehabilitation Unit following acute cardiovascular disease. Adherence to MD was assessed in 111 patients admitted to the Cardiac Rehabilitation Unit of the Federico II Hospital in Naples. The Medi-Lite score was used to assess adherence to MD. The main determinant of reduced MD compliance was assessed using Pearson's correlation analysis and a multivariable regression model. The population had a median MD adherence score of 11 and a mean score of 10.9. The lowest possible score was 5 (indicating poor adherence), and the highest possible score was 15 (excellent adherence index). There were 3 participants with a poor score (<7), 82 with a good score (7-12), and 26 with an excellent score (³13). Lower Medi-Lite score was associated with younger age and being an active worker in a multivariate regression model (both p<0.05). Our findings show that among patients admitted to the Cardiac Rehabilitation Unit after a major CV event, young active workers have the lowest adherence to MD, requiring an individualized and multidisciplinary approach to improve their adherence to MD for secondary CV prevention.

Adherence to the Mediterranean diet in patients with coronary artery disease referred to a cardiac rehabilitation program in a Mediterranean island (Mallorca)

Abstract Funding Acknowledgements Type of funding sources: None. Introduction A Mediterranean diet (MedDiet) is recommended in ESC guidelines to lower the risk of cardiovascular disease (CVD) and it’s part of the secondary prevention treatment in patients with coronary artery disease (CAD) Purposes To investigate the degree of adherence to the MedDiet in patients with CAD treated at a cardiac rehabilitation (CR) unit in Mallorca. To study wether the degree of adherence to the MedDiet correlates to any health-related characteristic of these patients. Methods Retrospective observational study. The degree of adherence to the MedDiet was measured using the 14-points MEDAS-14 questionnaire (validated in the PREDIMED study) administered by a trained nurse to patients with CAD referred to the CR program. A score of 0 to 8 points is considered low adherence, 9 or more is considered an acceptable adherence. We measured the relationship between the degree of adherence to the MedDiet and the presence cardiovascular risk factors, weight and body mass index (BMI), lipid and glycemic profile, and degrees of anxiety and depression measured by the hospital anxiety and depression scale (HADS). Results Since 2014, 485 patients with CAD have been treated in the CR program (83% of them after an acute coronary syndrome -ACS-). Their mean age was 56 ± 9 years and 84% were men. Their average weight was 85 ± 15 kg. The mean BMI was 29.2 ± 4 (44% overweight, 39% obese). The degree of adherence to MedDiet in these patients was low in 30% of patients and acceptable in 70%. The mean score obtained in the MEDAS-14 questionnaire was 9.3 ± 2,0 points. There were no significant differences in the degree of adherence to the MedDiet between men or women. Nor were significante differences whether or not the patient was diabetic, overweight or obese. Patients who had never smoked had greater adherence to the MedDiet (9.8±2 vs 9.1± 2, p: 0.02) and a higher percentage of them had an acceptable adherence compared to the smokers or former smokers (81 vs 67%, p: 0.01). The youngest patients (below the mean age of the group) had a worse adherence to the MedDiet (8.9 ± 3 vs 9.6 ± 2, p: 0.007) There were no significant differences in weight, BMI, LDL cholesterol, Triglycerides or HbA1c levels between patients with low and acceptable adherence to the MedDiet. Patients with high levels of anxiety or depression measured in HADS obtained similar scores of adherence to MedDiet to people who had a better psicosocial profile. Conclusions Patients with CAD treated in a CR unit in Mallorca have acceptable levels of adherence to the Mediterranean diet, better than those seen in the general population or in other CAD patient samples previously published (1,2). The information received at hospital discharge after a recent ACS could have already caused changes in the eating pattern. Young patients and smokers or former smokers have lower adherence to the MedDiet.

Evaluation of treatment adherence and lifestyle modification of moroccan patients with chronic heart failure in cardiac rehabilitation

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Cardiac rehabilitation consists of measures that allow patients to recover their functional capacity through physical exercise and therapeutic education. The aim of our study is to evaluate the treatment adherence and lifestyle modification of patients with chronic heart failure in Cardiac Rehabilitation. Materials and methods It’s a prospective study included 50 patients with chronic heart failure with reduced ejection fraction (HFrEF), admitted in Cardiac Rehabilitation Unit, Cardiology Centre. All of them had clinical evaluation, echocardiography, cardio respiratory evaluation and Education Program. Results The average age of patients was 68, 36±9,3 years with male predominance, they have more than three cardiovascular risk factors dominated by smoking and hypertension, coronary artery disease is the most frequent etiology, they had reduced ejection fraction (EF: 31±6,2%), 53% of patients respect dietary rules and adhere totally to treatment, 34% of patients don't respect diet rules and stopped treatment itself and 13% take irregularly treatment. After 20 sessions of Exercise training and Education Program; patients have a good quality of life, they become less symptomatic (from dyspnea class III to II of NYHA), they adhere more to diet rules and take regularly their treatment. Conclusion This study demonstrated that Cardiac Rehabilitation help patients with Chronic Heart Failure to modify their lifestyle, to respect diet rules and adhere more to treatment.

Cardiac Rehabilitation during COVID-19

Funding AcknowledgementsType of funding sources: None.IntroductionThe global COVID19 pandemic has led to significant morbidity and mortality to millions of cardiac patients across the globe. Inferior clinical standards, modified clinical pathways and limited hospital resources has unfortunately translated to significant premature cardiac deaths. Cardiac rehabilitation has also been hit significantly.Study ObjectivesThe aim of this study was to assess the impact of cardiac rehabilitation during COVID-19, comparing the referral, adherence and outcomes with patients admitted a year previously.MethodologyPatients were divided in two groups. Group 1 were those admitted between March-August 2019 (Pre-COVID). Group 2 included those admitted between March-August 2020 (during COVID). Program completion was defined as adherence to ≥6 sessions (Group 1) or ≥ 4 sessions (Group 2). Data was collected from electronic case summaries and cardiac rehabilitation unit medical records. Data was tabulated in SPSS v23. Categorical variables were presented as percentages. Statistical analysis was computed with SPSS v23. A p value of <0.05 was deemed statistically significant.Results710 patients were admitted with a cardiac diagnosis (Group 1 n=360, Group 2 n=350), mean age 66.71 ± 13.21 years, dominant male population (n=548, 77.2%). Both groups had comparable proportions of smoking, hypertension, diabetes and hyperlipidaemia.The referral rate to cardiac rehabilitation was rather poor in both groups, though better in Group 1 (Group 1 38.3% vs 26.6%, p=0.001), partly because of temporary discontinuation of the rehabilitation program at the start of the pandemic. The completion rate was also unfortunately quite low. It was better in Group 2, possibly because of the shorter program duration (Group 1 23.5% vs Group 2 38.7%, p=0.018).The 1 year readmission rate was significantly higher in Group 1 (22.8% vs 15.1%, p=0.022)), possibly because patients were more open to seek medical advice before the pandemic. The 30 day death rate was comparable in both groups (5.0% vs 5.7%, p=0.672). The 1 year mortality was also comparable (Group 1 12.5% vs Group 2 10.6%, p=0.481) Cardiac rehabilitation did not impact the 1 year readmission rate, 30 day and 1 year mortality.ConclusionThe 30 day and 1 year mortality in patients admitted during the first 6 months of the pandemic was comparable to the same timeframe the year before. The 1 year readmission rate was higher in patients admitted before COVID, possibly explained by patients being more inclined to seek medical advice. Referral to cardiac rehabilitation was generally low. Adherence to the program did not impact readmission and mortality.

Short-term treatment of iron deficiency anemia after cardiac surgery.

Iron deficiency anemia (IDA) is frequent after cardiac surgery and is associated with increased morbidity and mortality. In a retrospective study, we analyzed 106 patients with IDA (hemoglobin [Hb] ≤ 12 g/dl in women and ≤ 13 g/dl in men, transferrin saturation [TSAT] ≤ 20%) on admission to a Cardiac Rehabilitation Unit after cardiac surgery. The patients were divided into two groups, one was treated with oral sucrosomial iron (SI) and the other with intravenous ferric carboxymaltose (FCM). Patients received a single 1000 mg dose of FCM from the day after admission to rehabilitation (T1), or a 120 mg/day dose of SI from T1 until discharge (T2); after discharge, SI was reduced to 30 mg/day until the end of follow-up (T3). Hb was evaluated at T1, T2 and T3; the other hematological parameters at T1 and T3; natriuretic peptides at T1, T2 and T3; 6-minute walk test (6MWT) at T1 and T2. Folate, vitamin B12 and reticulocytes were sampled on admission. Folate deficiency was documented in 60.4% of patients. Hb increased in both groups with no significant differences between the two treatments (p = 0.397). The other iron metabolism parameters (sideremia, transferrin, TSAT) displayed similar behavior, showing a significant increase at T3 (p < 0.001) with both therapies, although the increase was faster with FCM. Ferritin – high on admission – decreased at T3 in the SI group and rose significantly in the FCM group (SI 219.5 vs. FCM 689 ng/ml p < 0.0001). The 6MWT increased significantly at T2, with an overlap between SI and FCM. In conclusion, the results of this study show that SI and FCM exhibit the same effectiveness on IDA; the response time to therapy of both treatments is also equally fast. SI and FCM induce a similar increase in functional capacity. The study shows that SI can be a viable alternative to FCM after cardiac surgery in terms of effectiveness and tolerability.

"Medical Assistance in Contextual Awareness" (AMICO): A Project for a Better Quality of Care for Patients in Cardiac Rehabilitation Unit.

The "Medical Assistance in Contextual Awareness" (AMICO) project proposes an infrastructure, called an "instrumented environment", consisting of the home environment and the person, both of which are suitably equipped with sensors, a telemedicine service platform (in the Internet of Things) and a Robot who acts as a mediator/master between the person, the surrounding environment and the external environment. This infrastructure, oriented to the citizen's well-being, can offer both services oriented to the person in his home environment, monitoring their behavior and psycho-physical state, and telemedicine services to support the remote monitoring of citizens affected by a cardiovascular event undergoing rehabilitation therapies from part of doctors or caregiver.