Short-term Cardiac Rehabilitation Research Articles

Effects of Water-Based Exercise on Patients Older than 60 Years Undergoing Cardiac Rehabilitation after Coronary Intervention.

Cardiac rehabilitation (CR) plays a crucial role in managing patients who have undergone coronary intervention (CI) following acute myocardial infarction. While water-based exercise is gaining recognition as an exercise modality in this patient population, its impact on the subgroup of older adults remains unexplored. In this post hoc analysis, we investigated the effects of water-based exercise on adults older than 60 years undergoing CR after CI, comparing it to land-based exercise and a control group. In total, 45 patients aged over 60 participated in 14-day exercise programs, featuring two daily 30-min sessions. We assessed exercise capacity (VO2peak), vascular function (flow-mediated vasodilation (FMD)), heart rate variability (HRV), and blood markers (Interleukins 6, 8, and 10, P-Selectin, ICAM, and High-sensitivity CRP) before and after CR. VO2peak in the water-based group improved significantly after CR in comparison with the land-based group: 1.35 kg/mL/min (95% CI [0.20-2.50], p = 0.022). The significant difference between water-based and land-based groups was observed in several HRV parameters: Total power -1129.20 ms2 (95% CI [-1951.92--306.49], p = 0.008); peak LF 0.04 Hz (95% CI [0.00-0.08], p = 0.036); SD1 -9.02 millisecond (95% CI [-16.86--1.18], p = 0.025); and SD2 -19.71 ms (95% CI [-35.08--4.34], p = 0.013). FMD and blood markers did not vary significantly based on the exercise group. These findings suggest that short-term water-based CR may have potential as an alternative to traditional land-based CR, improving VO2peak and cardiorespiratory fitness among adults over 60 years undergoing CR after CI.

The Edmonton frail scale is a tool to evaluate the effectiveness of cardiac rehabilitation in frail older patients after open cardiac surgery

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Together with the aging population, the part of older frail patients after cardiac surgery is increasing in cardiac rehabilitation (CR) settings. Frailty detection is crucial for choosing appropriate training programs, but according to the literature, there is not enough evidence on what tools should be used to detect frailty and evaluate its dynamics during CR. Purpose To evaluate the effectiveness of CR for older frail patients after open heart surgery using the Edmonton frail scale. Methods A prospective, randomized controlled clinical trial. Inclusion criteria: all patients were admitted to CR after open heart surgery, ≥ 65 years old, within 6-minute walking distance (6-MWD) ≥150 m, Edmonton frailt scale (EFS) score ≥ 4, patient’s agreement to participate in the study. Patients (N=100, 73,3±5,1 years, 17,1±7,4 days post-surgery, 62,0% male)) were randomly allocated for gender assigned (1:1 ration) to intervention or control groups (IG n=50, CG n=50). Both groups participated in exercise training during inpatient-CR. After completing the 20-day rehabilitation program, the intervention group (IG) participated in home-based exercise training that lasted 12 weeks. The home-based exercise training program included four different types of exercise: aerobic endurance training (5/week, 20–60 min) including walking, stair climbing, and cycling of moderate to high intensity; sensomotoric training (3/week, 15 min) including exercises on postural control, dynamic balance, and coordination of moderate to high intensity; resistance training (3/week, 20–25 min) including 4 – 8 exercises at moderate intensity, involving main muscle groups of the legs; flexibility training (3/week, 10–15 min) including isolated type flexibility exercises at low to moderate intensity. Participants of IG were monitored by phone calls every two weeks and the CG were assigned to usual care. Patients were assessed before (T1) and after 20-days inpatient CR (T2) and 12 weeks after completion of CR (T3). Patients' frailty was evaluated between groups and over time by the Edmonton frail scale (frail ≥ 6, prefrail 4-5, robust 0-3). SPSS 22 was used for statistical analysis. The Mann-Whitney U and chi-squared tests were applied to compute p-values for the differences between the groups and periods. Results There were no significant differences in patient characteristics between the groups except that in CG there were more women (p=0,013). As a result of inpatient-CR and home-based exercise training program prevalence of frailty decreased in both groups, but no statistical significance between the groups was observed. (Table 1). Conclusions EFS is a suitable tool to detect frailty and evaluate its dynamic during short-term CR (after 20 days) and medium-term (after 12 weeks) home-based CR programs. The results are encouraging, but probably because of the small sample size and short monitoring time, no significant differences were found between the groups.

Frailty and Different Exercise Interventions to Improve Gait Speed in Older Adults after Acute Coronary Syndrome.

Background and Objectives: The world’s population is rapidly aging, and it is estimated that, by 2050, every sixth person on earth will be older than 65 years. Around 30% of older adults entering cardiac rehabilitation (CR) meet the criteria of frailty. Frailty identification has not been included in the routine evaluation of CR patients yet, and there is a lack of evidence on what training regimen for improving physical performance in frail people is optimal. Therefore, the aim of our study was to determine the prevalence of frailty and to evaluate the effect of two different complementary training programs on the gait speed of older vulnerable and frail patients with acute coronary syndrome and mid-range-to-preserved left ventricular ejection fraction (≥40%) during short-term CR. Materials and Methods: This randomized controlled trial was conducted from January 2020 to September 2021. CR participants (n = 97) with a mean age of 73.1 ± 5.3 years were randomly allocated into three groups: control (CG, n = 32), intervention-1 (IG-1, n = 32) and intervention-2 (IG-2, n = 33). The patients of all three groups attended a usual inpatient CR program, and two intervention groups additionally received different resistance and balance training programs 3 days a week: the IG-1 underwent complementary training with traditional means of physical therapy, while the IG-2 underwent complementary training with mechanical devices. The mean CR duration was 18.9 ± 1.7 days. Frailty was assessed with the Edmonton Frail Scale, and the 5 m walk test was used to evaluate gait speed. Results: Frailty was determined in 37.1% of participants, and 42.3% met the criteria of being vulnerable. After CR, the gait speed of frail and vulnerable patients significantly improved in all three groups (p < 0.05). In the IG-2, slow gait speed was reversed to normal in the overwhelming majority of patients (p < 0.05), while the CG had the greatest proportion of patients who remained to be slow after CR (p < 0.05). Conclusions: A considerable part of patients entering CR are frail or vulnerable; therefore, it is of crucial importance to assess frailty status in all older people. All three CR programs improved gait speed in frail and vulnerable older patients with ischemic heart disease. Complementary resistance and balance training with mechanical devices more effectively reversed slow gait speed to normal during short-term CR.

Long-Term Enrollment in Cardiac Rehabilitation Benefits of Cardiorespiratory Fitness and Skeletal Muscle Strength in Females with Cardiovascular Disease.

Background: The benefits of short-term cardiac rehabilitation (CR) for improving fitness are well known, but the effects of long-term maintenance-phase CR are less well established. Moreover, changes in cardiorespiratory fitness (CRF) and muscle strength with long-term CR have never been examined specifically in females, a population that is under-researched and under-represented in cardiovascular research. The objective of this retrospective pilot study was to estimate changes in CRF and muscle strength in females enrolled in a long-term CR program.Methods: Data from 39 females (mean ± standard deviation age 65 ± 9 years) enrolled for at least 1 year in a maintenance-phase CR program were analyzed. The program consisted of aerobic and resistance training, and data were collected annually for CRF (peak oxygen consumption [VO2peak, mL/kg/min]) and skeletal muscle strength (one-repetition maximum tests for chest press, seated row, and knee extension, kg). Mixed-model analyses were used to determine changes in CRF over the 5-year follow-up (203 observations) and muscle strength over 6 years (108 observations).Results: The CRF increased in females by 1.8%/year over 5 years of CR enrollment, and muscle strength increased by 0.6%–2.1%/year over 6 years. These findings are in contrast to the expected age-related declines in fitness over time.Conclusion: The positive long-term benefits on CRF and muscle strength in females provide initial preliminary support for maintenance-based CR, especially given that this population is commonly under-researched and under-represented in the CR literature.

Absence of exercise capacity improvement after in-hospital short-term cardiac rehabilitation is associated with long-term clinical outcome in heart failure patients

Abstract Background Previous studies suggest Cardiac rehabilitation (CR) improve exercise capacity and decline mortality in heart failure (HF) patients. However, some studies show there are HF patients who do not improve exercise capacity by CR and these patients have a higher risk of adverse events in long-term clinical outcome. We investigated whether absence of exercise capacity improvement after in-hospital short-term CR also has adverse effect in long-term clinical outcome. Methods In this retrospective study, 130 HF patients who underwent two weeks in-hospital CR after received standardized HF treatment between July 2014 and August 2020 were included. Improvement in exercise capacity was assessed by change in peak oxygen consumption (delta-Peak VO2) measured at 1st and 14th day of CR by cardiopulmonary test. The median delta-PeakVO2 was 1.3 ml·kg-1·min-1. Patients were classified as responder if they demonstrated delta-PeakVO2 ≥1.3 ml·kg-1·min-1 and as non-responder if they demonstrated delta-PeakVO2 &amp;lt;1.3ml·kg-1·min-1. MeanΩ follow-up was 1236 days. The primary outcome was all-cause death. Result 63 patients (48.4%) were classified as non-responder. Non-responders were older (75.5±10.6 vs 70.8±11.0, P=0.01) and lower estimated glomerular filtration rate (eGFR) (49.7±19.4 vs 57.9±19.2) and lower albumin (3.5±0.5 vs 3.7±0.3 g/dL, P=0.04) than responders. Transtricuspid pressure gradient (TRPG) measured by transthoracic echocardiography was also higher in non-responders (28.5±10.9 vs 22.7±6.3). Predictor of non-responders were TRPG (OR = 1.1, 95% CI 1.02–1.26) and albumin (OR =0.04, 95% CI: 0.003–0.40). In multivariate analysis including delta-PeakVO2 &amp;lt;1.3 ml·kg-1·min-1 (non-responder), age &amp;gt;75, male gender, PeakVO2 at 1st day of CR, body mass index (BMI), left ventricular ejection fraction measured by transthoracic echocardiography, medication of β-blockers showed that delta-PeakVO2 &amp;lt;1.3 ml·kg-1·min-1 (HR =2.8, 95% CI 1.0–7.5), age&amp;gt;75 (HR11.2, 95% CI 2.1–60.1), BMI (HR =0.8, 95% CI 0.6–0.96) were associated with all-cause death. Conclusion The absence of exercise capacity improvement after in-hospital short-term CR was the risk of all-cause death. Especially, the HF patients with higher TRPG and lower albumin have a higher probability of becoming a non-responder. Funding Acknowledgement Type of funding sources: None.

Cardiac Rehabilitation and Complementary Physical Training in Elderly Patients after Acute Coronary Syndrome: A Pilot Study.

Background and Objectives: Nearly 23% of elderly patients hospitalized due to acute coronary syndrome have reduced muscle strength. It is assumed that these patients would better benefit from a complex training—a combination of endurance, strength, balance, coordination, and flexibility—in order to reduce the loss of muscle strength and mass and improve functional capacity. The aim of this study was to assess the effectiveness and safety of two different complementary resistance and balance training programs during short-term cardiac rehabilitation (CR) in elderly patients after a percutaneous or surgical intervention due to acute coronary syndrome. Materials and Methods: This randomized controlled trial was conducted from January 2020 to February 2021 in one Lithuanian rehabilitation hospital. A total of 63 participants who met the inclusion criteria were randomly assigned to three groups (at the ratio of 1:1:1): control (CG, n = 19), intervention 1 (IG-1, n = 26), and intervention 2 (IG-2, n = 18). All the patients attended a usual inpatient CR program of a mean duration of 18.7 ± 1.7 days, while the patients assigned to the intervention groups (IG-1 and IG-2) additionally received different resistance and balance training programs three days a week. Functional capacity, with 6-minute walk test (6MWT) and cardiopulmonary exercise testing (CPET), as well as physical performance, with the short physical performance battery (SPPB) test and one repetition maximum test (1RM) for leg press, were assessed at baseline and after CR. Results: The mean age of the participants was 72.9 ± 5.5 years; 73% were men. All parameters of functional capacity and physical performance improved significantly after CR (p < 0.05), except for peak VO2 that improved only in the IG-1. Comparison of CR effectiveness among the groups revealed no significant differences. Conclusions: All three rehabilitation programs were safe and well tolerated by elderly patients aged ≥65 years as well as improved functional capacity (6-minute walk distance and peak workload) and physical performance (SPPB and 1RM). Complementary resistance and balance training with traditional physical therapy means and exercises with mechanical devices did not show greater benefits for the results of physical performance compared with the usual CR program.

Influence of inspiratory muscle strength on exercise capacity before and after cardiac rehabilitation

Background/Aims Coronary artery bypass grafting is a complex procedure that triggers a series of clinical and functional complications. The reduction of inspiratory muscle strength that persists during the late postoperative period has been suggested as an important determinant of functional capacity after coronary artery bypass grafting. The aim of this study was to investigate whether inspiratory muscle strength, functional capacity and quality of life are determinants of exercise capacity before and after a short-term phase II cardiac rehabilitation programme in patients who have had coronary artery bypass graft surgery. Methods A prospective quasi-experimental study was undertaken with 20 patients who had recevied coronary artery bypass surgery. All patients completed a short-term, moderate-to-high intensity inspiratory muscle training programme, followed by aerobic and resistance exercise, two times a week for 12 weeks, totalling 24 sessions, under the direct supervision of a physical therapist. Results Pre-intervention, peak oxygen consumption (peak VO2) was associated with maximum inspiratory pressure (β=0.037; 95% confidence interval 0.01–0.06; P=0.002). Post-intervention, peak VO2 was associated with maximum inspiratory pressure (β=0.03; 95% confidence interval 0.007–0.053; P=0.014) and the 6-Minute Walk Test (β=0.007; 95% confidence interval, 0.001–0.013; P=0.024). Conclusions Inspiratory muscle strength influences exercise capacity before and after a short-term cardiac rehabilitation programme in patients who have had coronary artery bypass graft surgery.

Role of early short-term cardiac rehabilitation in patients undergoing pacemaker implantation.

Exercise-based cardiac rehabilitation (CR) improves the clinical outcomes in patients with cardiovascular diseases. However, few data exist regarding the role of early short-term CR in patients undergoing pacemaker (PM) implantation. We assessed whether short-term CR following PM implantation was sufficient to improve both physical function and quality of life (QOL). A total of 27 patients with a 6-minute walking distance (6MWD) of less than 85% of the predicted value on the day following PM implantation were randomly assigned to either the CR group (n = 12, 44.4%) or the non-CR group (n = 15, 55.6%). The CR group involved individualized exercise-based training with moderate intensity for 4 weeks after PM implantation. Cardiopulmonary exercise test (CPET), 6MWD, muscle strength, and Short Form (SF)-36 were assessed at baseline and at the 4-week follow-up. After a mean follow-up period of 38.3 days, both groups showed significantly improved 6MWD. Peak oxygen uptake improved in both groups on CPET, but the difference was not statistically significant. Knee extension power and handgrip strength were similar in both groups. Regarding QOL, only the CR group showed improved SF-36 scores in the items of vitality and mental health. There was no difference in any subscale in the non-CR group. Neither lead dislodgement nor significant changes in PM parameters were observed in any patient. Early short-term CR following PM implantation was associated with improved psychological subscales and can be safely performed without increasing the risk of procedure-related complications.

Effects of Long-Term and Short-Term Cardiac Rehabilitation Programs on Cardiovascular Risk Factors and Physical Fitness after Percutaneous Coronary Intervention

BackgroundCardiac rehabilitation programs reduce the likelihood of relapse and cardiac arrest in patients with cor-onary artery disease. The goal of this study was to compare and analyze changes in cardiovascular risk factors and physical fitness in patients who participated in short-term (ST) and long-term (LT) cardiac rehabilitation programs following coronary artery percutaneous coronary intervention (PCI).&#x0D; MethodsThis study included 193 men aged ≥45 years who received PCI for coronary artery occlusive disease. The participants were divided into ST program participants (3 months, 108 participants; ST group) and LT program participants (12 months, 85 participants; LT group). Blood lipids analysis, body composition, and physical fitness tests were performed to assess cardiovascular risk factors and physical fitness. Paired t-test and two-way ANOVA with repeated measures were used to investigate the effect of the intervention. ResultsBoth groups had significant improvements after cardiac rehabilitation in body fat, high-density lipoprotein cholesterol, exercise duration, heart rate (HR) at rest, double product peak, VO2 peak, 6-min walking, and sit-to-stand, compared to baseline. The LT group also had significant improvements after cardiac rehabili-tation in waist circumference (WC), total cholesterol (TC), triglyceride (TG), and HR peak. LT group had significantly improved effect than ST group in WC, TC, TG, exercise time, HR peak, and 6-min walking.&#x0D; ConclusionThe cardiac rehabilitation program led to improved cardiovascular risk factors and physical fitness, and the LT program was more effective than the ST program.

A large-scale cohort study of long-term cardiac rehabilitation: A prospective cross-sectional study

BackgroundFew studies have evaluated the therapeutic effect of long-term cardiac rehabilitation (CR) and no large-scale survey of cardiovascular outcomes after long-term CR is reported. MethodsThis cohort study included 9981 patients undergoing CR from 2004 to 2015. Patients who had supervised CR were divided into three groups according to CR duration: up to acute phase (until discharge, Phase I group), up to recovery phase (≤150 days, Phase II group), and up to maintenance phase (>150 days, Phase III group). Using propensity score matching, mortality and major adverse cardiovascular events (MACE) were compared among the groups. ResultsFollow-up period was 4.9 ± 3.0 years. Adult patients were divided into three groups (Phase I group: n = 4649, Phase II group: n = 3271, and Phase III group: n = 731). After propensity score matching, the risk of death and MACE was extremely lower in Phase III group than in Phase I or Phase II group (death: HR 0.47, P < 0.01, HR 0.64, P < 0.01, and MACE: HR 0.48, P < 0.01, HR 0.70, P < 0.01). Most patients in Phase II group had better survival than those in Phase I group. Subpopulations of female patients and those with dyslipidemia, smoking history, coronary artery bypass graft, or heart failure had better survival in Phase III group than in Phase II group. ConclusionsLong-term supervised CR for patients with cardiovascular diseases is more effective than short-term CR.

Performance Measures for Short-Term Cardiac Rehabilitation in Patients of Working Age: Results of the Prospective Observational Multicenter Registry OutCaRe

ObjectiveTo determine immediate performance measures for short-term, multicomponent cardiac rehabilitation (CR) in clinical routine in patients of working age, taking into account cardiovascular risk factors, physical performance, social medicine, and subjective health parameters and to explore the underlying dimensionality. DesignProspective observational multicenter register study in 12 rehabilitation centers throughout Germany. SettingComprehensive 3-week CR. ParticipantsPatients (N=1586) ≤65 years of age (mean 53.8±7.3y, 77.1% men) in CR (May 2017-May 2018). InterventionsNot applicable. Main Outcome MeasuresFeasibility, defined by data availability for ≥85% of patients (CR admission and discharge), and modifiability based on pre-post comparison (statistical significance, with P value<.01; standardized effect size≥.35; change by ≥5% points in categorical variables). In addition, latent factors were identified using an exploratory factor analysis (EFA). ResultsBased on feasibility and modifiability criteria, smoking behavior, lifestyle change behavior, blood pressure, endurance training load, depression in Patient Health Questionnaire-9 (PHQ-9), the 5-item World Health Organization Well-Being Index (WHO-5), physical and mental health and pain scale of the indicators of rehabilitation status-24 (IRES-24), and self-assessed health prognosis proved to be suitable performance measures. As a result of the EFA, 2 solid factors were identified: (1) subjective mental health including PHQ-9, WHO-5, mental health (IRES-24), mental quality of life, and anxiety and (2) physical health including physical quality of life, physical health and pain scale of IRES-24, and self-assessed occupational prognosis. A third factor represents the blood pressure. ConclusionsWe provide a small set of performance measures, that are essentially based on 3 latent factors (subjective mental health, physical health, blood pressure). These performance measures can represent immediate success of comprehensive CR and be applied easily in clinical practice.

Effect of Short-Term Cardiac Rehabilitation on Quality of Life According to Socioeconomic Status

BackgroundCardiac rehabilitation (CR) lowers the recurrence of cardiovascular disease and has strong and posi-tive physical and psychological effects. The purpose of this study was to analyze the quality of life (QoL) of CR participants according to their monthly income and education levels in the early phase after percutaneous coronary intervention (PCI). Material and methodsThere were 128 participants (98 men and 30 women). Their socioeconomic status (SES) was evaluated and QoL was assessed using the 36-item Short Form Health Survey. CR was initiated 3 weeks after treatment and remeasured after 3 months. The pre-post analysis was performed using the paired t-test. The participants’ education levels were defined in terms of a middle school group (low education [LE]), high school group (middle education [ME]), and above college group (high education [HE]). Monthly household income was divided into tertiles: up to US$2000 (low income [LI]), up to US$4000 (middle income [MI]), and more than US$4000 (high income [HI]). ResultsThere was a significant increase in mental health status—from 54.9 to 63.3—in the HE group, but no significant changes were observed in the LE and ME groups. Physical changes were observed in all education-level groups.The physical changes in the group according to monthly income significantly increased by 9.1% (66.8– 73.5) in the LI group, 7.8% (65.9–71.5) in the MI group, and 12.1% (62.7–71.3) in the HI group. Physical changes were observed in all monthly income groups. Changes in occupational physical activity levels sig-nificantly improved physical and mental status in the middle and high activity groups, but not in the low activity group. ConclusionChanges in QoL as an effect of short-term CR were effective. Changes in mental QoL were significant in higher SES levels and physical QoL was effective in all groups.

P2261The impact of a short-term cardiac rehabilitation program on activities of daily living in elderly patients with chronic heart failure

Abstract Introduction A high proportion of elderly patients with Chronic Heart Failure (CHF) experience dyspnea and fatigue during the activities of daily living (ADLs). Purpose We aimed to determine 1) the VO2 peak of some basic ADLs comparing it to VO2 peak at CardioPulmonary Exercise Test (CPET) and 2) the effects of 3-week inpatient cardiac rehabilitation program on ADLs' performance. Methods At entry and at the end of a 20-day cardiac rehabilitation program patients performed an ADL-test consisting of five task-related ADL activities and two time-related ADL activities while wearing a metabolimeter mobile device (K5, Cosmed). Task-related activities were: 1) to put on and take off socks, shoes and jacket (ADL 1); 2) to fold eight towels (ADL 2); 3) to put 6 bottles on a shelve (ADL 3); 4) to make a bed (ADL 4); 5) to go up and down 1-floor stairs (ADL 5). Time-related ADL activities were: 1) to sweep the floor for 4 minutes (ADL 6) and 2) to walk for six minute (6MWT). Metabolic load, oxygen uptake, ventilation, heart rate and symptom of dyspnea were computed for each ADL. During the program, patients performed a CPET. Results Fifty-six CHF patients [89% men; age 72±6 years; Ejection Fraction (EF) 38±12%; 66% with EF&lt;40%] were enrolled. At entry, the least demanding ADL [expressed as proportion of peak oxygen uptake (VO2 peak) reached at CPET] was ADL 3 with 53,14±18.53%, while the most challenging was the 6MWT with 116.81±34.48%. Forty-two (75%) patients reached the VO2peak of CPET during 6MWT. After rehabilitation, there was a significant decrease in the time required to perform the task-related activities (ADL 1–5) [from 382.25±114.90 to 354.48±116.92 seconds, p=0.0175] and a significant increase in the distance covered during 6MWT [from 421.35±81.64 to 448.84±89.69 meters, p=0.000]. Moreover, following rehabilitation a significant decrease of heart rate in ADL1, ADL 3 and ADL 5 and a significant decrease of dyspnea in ADL 5, ADL 6 and 6MWT was recorded. Conclusion A comprehensive cardiac rehabilitation program can improve ADL performance due to the change of some physiological variables during effort. Further studies about the role of dedicated rehabilitation program (i.e. occupational rehab) are necessary.

Improvement of low-density lipoprotein cholesterol target achievement rates through cardiac rehabilitation for patients after ST elevation myocardial infarction or non-ST elevation myocardial infarction in Germany: Results of the PATIENT CARE registry.

The PATIENT CARE registry aimed to document clinical characteristics of patients during cardiac rehabilitation after myocardial infarction, including the current pharmacological treatment, risk factor modification and achievement of treatment targets for low-density lipoprotein cholesterol (LDL-C). Multicentre, prospective non-interventional study at 20 cardiac rehabilitation in-patient centres across Germany. A total of 1408 patients post myocardial infarction were analysed. Patients' mean age was 62 ± 11 years and 27.0% were women. ST elevation myocardial infarction ( n = 657; 48.7%), and non-ST elevation myocardial infarction ( n = 617; 45.8%) were equally balanced causes for hospitalization, while previous coronary artery bypass grafting was reported in n = 134 patients (9.9%). On average, cardiac rehabilitation began 19 ± 10 days after the index event and lasted for 22 ± 4 days. At discharge, 96.7% of patients received statins, 13.0% another lipid-lowering medication in addition to a statin, 98.5% antithrombotic drugs and 22.3% antidiabetic medication. The rate of patients with LDL-C on target according to the European Society of Cardiology/European Atherosclerosis Society dyslipidaemia guidelines 2011 (<70 mg/dl (1.8 mmol/l) or at least 50% reduction of baseline value) was increased from 21.4% at admission to cardiac rehabilitation to 41.9% at discharge after cardiac rehabilitation. Most patients (95.2%) completed the cardiac rehabilitation and 88% returned to their former work at full time. During cardiac rehabilitation, the modifiable cardiovascular risk factors, in particular the LDL-C, were substantially improved in patients after myocardial infarction. The great majority were able to return to work. However, less than 50% reached the LDL-C guideline targets during short-term cardiac rehabilitation.

Effect of Type D Personality on Short-Term Cardiac Rehabilitation in Patients With Coronary Artery Disease

ObjectiveTo investigate the effect of type D personality on cardiac rehabilitation (CR) participation rates and the effect of a short-term CR program.MethodsStudy participants included patients diagnosed with acute coronary syndrome who underwent percutaneous coronary intervention. Patients completed the Type D personality Scale (DS-14) and the Hospital Anxiety and Depression Scale (HADS) at program entry. Subjects were recommended participation in 6 weeks of CR exercise training. Cardiopulmonary exercise test (CPET) was conducted before and after completion of the training. CR participation refers to completion of the 6-week CR exercise program and performance of the secondary CPET. Drop-out refers to the subjects who were unable to participate in the 6-week CR exercise program or to perform the secondary CPET.ResultsAt baseline, type D personality was evident in 21 of 63 patients (33.3%). Type D patients were more often depressed (57.1%) and anxious (38.1%) than non-type D patients (31.0% and 9.5%, respectively). At baseline, participants with type D personality showed a decreased body mass index (24.6 vs. 26.1 kg/m2, p=0.025). The type D group displayed a lower CR participation rate (5/21, 23.8%) compared with the non-type D group of (22/42, 52.4%). Logistic regression analysis revealed the association of type D personality with CR drop-out rate (odds ratio=3.87; 95% confidence interval, 1.2–12.5; p<0.05).ConclusionType D personality was independently associated with drop-out from CR program and with significantly higher levels of anxiety and depressive mood.

ACUTE MYOCARDIAL INFARCTION

Background: Death and morbidity are commonly occurred worldwide due toheart diseases and are becoming an increasingly important problem in the developing countriesincluding Pakistan. The left ventricular ejection fraction (LVEF) serves as a good assessmenttool to document beneficial effects of cardiac rehabilitation (CR) program in cardiac patients.Objectives: To evaluate the effect of short-term CR program on LVEF in patients with myocardialinfarction (MI). Study Design: Cross sectional and Case series study. Setting: Departments ofCardiology, Liaquat University Hospital, Hyderabad. Period: 1st January 2014 to 30th June 2014.Methods: 100 patients of less than 75 years of age with acute uncomplicated anterior wall oranterolateral wall MI, inferior and RV MI. Cases were randomized into two groups of age andsex matched 50 patients each. Group I (study group) patients were administered secondaryprevention advice and were started on the CR exercise protocol, Group II (control group) patientswere administered secondary prevention advice only. Results: At baseline, LVEF was 42.5% inthe study group and 41.4% in the control group patients and was statistically comparable. After10 weeks study group showed the LVEF of 47.78% and control group had LVEF of 42.26%. Thedifferences are being statistically significant. Conclusion: Significant improvement in LVEF inpatients who had been engaged in CR program besides the secondary prevention strategieswhen compared with the control group patients who followed secondary prevention strategiesonly. The present study is amplify the beneficial effects of simple CR program, which additionallyimproves the key cardiac parameters like LVEF in the recovery period.

ASSESSMENT OF LEFT VENTRICULAR EJECTION FRACTION IN PATIENTS UNDERGOING CARDIAC REHABILITATION FOLLOWING ACUTE MYOCARDIAL INFARCTION

Background: Death and morbidity are commonly occurred worldwide due toheart diseases and are becoming an increasingly important problem in the developing countriesincluding Pakistan. The left ventricular ejection fraction (LVEF) serves as a good assessmenttool to document beneficial effects of cardiac rehabilitation (CR) program in cardiac patients.Objectives: To evaluate the effect of short-term CR program on LVEF in patients with myocardialinfarction (MI). Study Design: Cross sectional and Case series study. Setting: Departments ofCardiology, Liaquat University Hospital, Hyderabad. Period: 1st January 2014 to 30th June 2014.Methods: 100 patients of less than 75 years of age with acute uncomplicated anterior wall oranterolateral wall MI, inferior and RV MI. Cases were randomized into two groups of age andsex matched 50 patients each. Group I (study group) patients were administered secondaryprevention advice and were started on the CR exercise protocol, Group II (control group) patientswere administered secondary prevention advice only. Results: At baseline, LVEF was 42.5% inthe study group and 41.4% in the control group patients and was statistically comparable. After10 weeks study group showed the LVEF of 47.78% and control group had LVEF of 42.26%. Thedifferences are being statistically significant. Conclusion: Significant improvement in LVEF inpatients who had been engaged in CR program besides the secondary prevention strategieswhen compared with the control group patients who followed secondary prevention strategiesonly. The present study is amplify the beneficial effects of simple CR program, which additionallyimproves the key cardiac parameters like LVEF in the recovery period.

Uticaj kratkih programa bolničke kardiološke rehabilitacije kod pacijenata sa akutnim infarktom miokarda lečenih primarnom perkutanom koronarnom intervencijom

Uticaj kratkih programa bolničke kardiološke rehabilitacije kod pacijenata sa akutnim infarktom miokarda lečenih primarnom perkutanom koronarnom intervencijom

The Effect of Short-Term Cardiac Rehabilitation After Acute Myocardial Infarction on High-Sensitivity C-Reactive Protein

High-sensitivity C-reactive protein (hsCRP) is an important biomarker of risk for coronary heart disease morbidity and mortality. We investigated the influence of short-term cardiac rehabilitation (CR) after acute myocardial infarction (AMI) on values of hsCRP and classical risk factors, including metabolic syndrome. hsCRP and classical risk factors were measured before and after completed 2-week CR program in 30 men after AMI. The comparison group comprised 30 age-balanced healthy men, with no risk factors for coronary heart disease. As expected, in comparison to healthy individuals, patients had higher values of hsCRP; furthermore, smokers had significantly higher hsCRP values than nonsmokers. Patients had more expressed markers of metabolic syndrome and due to pharmacological therapy lower blood pressure, total cholesterol and low-density lipoprotein cholesterol (LDL-C). After CR was completed, a significant drop in hsCRP (P=0.006) and improvement of metabolic syndrome parameters (lower body mass index, blood pressure, LDL-C, triglycerides) was observed in nonsmokers, whereas no such changes occurred in smokers. Our study revealed that hsCRP and metabolic syndrome parameters can be substantially reduced by a 2-week CR program; however, this effect is present only in nonsmokers. Thus, all patients entering the CR program after AMI should be advised to quit smoking before entering the program to achieve optimal benefits.

Influence of Short-Term Cardiac Rehabilitation on Oxidative Stress in Men After Myocardial Infarction Depends Upon Smoking Status

Oxidative stress is an important nonclassical risk factor for myocardial infarction (MI), and thus, it seems extremely important to recognize factors that effectively reduce it. The aim of our study was to explore possible influences of short-term cardiac rehabilitation (CR) of only 2 weeks in duration on oxidative stress in men after MI. Male patients (N = 21; aged 41-88 years, median 56 years), 6 to 8 weeks after acute MI, were included in our observational study using a pretest/posttest design. We investigated markers of oxidative stress and antioxidant enzymes before and after CR of only 2 weeks in duration and influence of smoking status on these differences. We found significant decrease in isoprostanes in urine in nonsmokers (n = 9) (P = .036) but not in smokers (n = 12) (not significant) during CR. After CR, nonsmokers had lower isoprostanes in urine (P = .039), lower non-transferrin-bound iron (P = .020), and higher erythrocyte catalase (P = .023) than smokers. Of classical risk factors, only low-density lipoprotein cholesterol was lower in nonsmokers before (P = .041) and after CR (P = .015) than in smokers. No other significant differences were seen at the beginning or at the end of CR. To our knowledge, the results of our study indicate for the first time that short-term CR of only 2 weeks in duration already has a positive effect on reduction of oxidative stress in the body. However, this positive effect is seen only in nonsmokers and not in smokers.