Journal of Cardiopulmonary Rehabilitation and Prevention最新文献

Purpose: To analyze the acute cardiovascular responses to arm-cranking (AC) exercise in patients with peripheral artery disease (PAD), comparing it to walking and a nonexercise control condition.

Methods: This study is a randomized crossover trial with single-blind data collection in which 17 patients with PAD and claudication (53% men, 66 ± 7 years old, 26.7 ± 4.4 kg/m 2 body mass index, 0.63 ± 0.12 ankle-brachial index) were included. They performed 3 experimental conditions (walking, AC, and control) in random order. The exercise conditions were composed of 15 bouts of 2 minutes (15 × 2) with an intensity equivalent to 4 to 6 on a modified (1-10) Borg Rating of Perceived Exertion scale. We measured blood pressure (BP), cerebral blood flow, heart rate variability, and brachial and femoral artery flow-mediated dilation before and after the conditions. Generalized estimated equations were used to analyze the acute response among experimental conditions, with P < .05 considered significant.

Results: We observed post-exercise hypotension in both AC and walking, with a greater net effect in the AC condition compared with walking (systolic BP: AC = -14 ± 14 mm Hg; walking = -6.7 ± 8.9 mm Hg, P < .001; diastolic BP: AC = -5.8 ± 8.4 mm Hg; walking = -1.2 ± 4.1 mm Hg, P = .011). Brachial and femoral artery flow-mediated dilation, cerebral blood flow, and heart rate variability did not change after any of the conditions.

Conclusion: Vascular function, cerebral blood flow, and heart rate variability remained unchanged after AC and walking. However, both walking and AC induced post-exercise hypotension in patients with PAD, with a greater magnitude in the AC condition.

Purpose: This study aimed to compare heart rate variability-guided (HRV-G) exercise training versus standard exercise training (SET) on peak oxygen uptake (V̇O₂peak) in patients experiencing an acute coronary syndrome event.

Methods: This randomized controlled trial included 48 patients randomized to HRV-G or SET. Both groups consisted of 3 aerobic exercise sessions per week for 3 months. For the HRV-G group, daily exercise was based on a 5-minute morning heart rate recording and the root mean square of successive differences between normal heartbeats (RMSSD). If RMSSD was within ±0.5 SD from baseline, a high-intensity interval training session was performed; if beyond ±0.5 SD, an active recovery session was prescribed. The SET group did 2 sessions of moderate-intensity continuous exercise and 1 session of high-intensity interval training per week, irrespective of HRV status.

Results: The V̇O₂peak increased significantly in both groups (+1.9 mL·kg-1·min-1, P = .002 for SET and +2.1 mL·kg-1·min-1, P < .001 for HRV-G) with no significant group-by-time interaction (P = .794). Fifty percent of patients were considered responders (ΔV̇O₂peak change post-pre >5%) in the SET group versus 75% in the HRV-G group (P = .111). There was a significant time-by-group interaction for V̇O2 at the first ventilatory threshold, adjusted for lean body mass, showing greater improvement in the HRV-G group compared with the SET group (P = .043). The training load was significantly lower in HRV-G.

Conclusions: In patients with coronary artery disease, HRV-G exercise training led to similar V̇O₂peak improvements and prevalence of responders but a larger improvement in V̇O2 at the first ventilatory threshold adjusted for lean body mass compared with SET, despite a lower training load.

Purpose: This study, based on a bibliometric analysis in the field of cardiac rehabilitation in Latin America, aims to (1) describe the number of publications per year, journal, country affiliation, and contributing authors; (2) identify collaborative networks; and (3) determine emerging research trends.

Review methods: A defined search strategy was implemented in Scopus for documents indexed up to September 2023. The retrieved records were analyzed using VantagePoint software (Search Technology, 15.2) to extract activity indicators (publication frequency, countries, institutions, and authors), relationship indicators (coauthorship among countries and authors), and research trends through author-included keywords in each article.

Summary: A total of 124 records were selected. The highest publication frequency was observed between 2019 and 2023, with Brazil and Canada leading in publication counts. Regarding international collaboration, studies were frequently coauthored by institutions in Brazil, Canada, Colombia, and the United States. Most records associated cardiovascular rehabilitation with cardiovascular diseases (coronary disease), exercise, and questionnaires. This investigation offers insights that are instrumental in shaping the trajectory of future studies by analyzing publication patterns and identifying potential collaborative partners in the region. Through a detailed examination of bibliometric data, it sets a foundation for advancing research agendas and fostering partnerships in cardiac rehabilitation within Latin America.

Purpose: We sought to develop an equation, the Alma College Estimation (ACE) equation, to estimate survival equivalent to the Duke treadmill score (DTS) and Duke nomogram.

Methods: Combinations of ST segment deviation (0, 1, 2, 3, and 4 mm), angina (0 = none, 1 = nonlimiting, and 2 = limiting), and metabolic equivalents of task (2-20) were graphed on the Duke nomogram, and the ACE equation was developed to predict annual mortality likelihood from nomogram measurements. Secondary analyses analyzed data from a clinical cohort of 10,673 patients who underwent a graded maximal exercise test at a county hospital in Sweden between 2005 and 2016. Following ACE equation development, survival estimates were compared between the equation to traditional line plotting on the Duke nomogram using mean absolute error and equivalence testing. Also, 5-year survival estimates from the ACE equation, nomogram, and DTS were categorized into low, intermediate, and high risk and compared using percent agreement.

Results: The developed ACE equation is a non-linear, exponential function. The 5-year survival estimates (100 - [5 × annual mortality risk]) from the ACE equation were significantly equivalent to within 1% of the nomogram ( P < .001, mean difference 0.1% ± 1.0%), with low mean absolute error (all combinations: 0.7% ± 0.7%, clinical cohort: 0.7% ± 1.0%). Percent agreement in risk categories ranged from 83% to 94%.

Conclusions: The ACE equation produced similar survival estimates to the Duke nomogram and DTS. This equation improves precision over the DTS and ease of use over the Duke nomogram, and therefore, may serve as a valuable tool for clinicians assessing prognosis from exercise test findings.

Purpose: Cardiovascular disease is a leading cause of morbidity globally, particularly in low-resource settings. The effectiveness of cardiac rehabilitation (CR) is well-established; however, the nature of services in low-resource settings differs. This study sought to investigate program characteristics associated with lower all-cause morbidity among CR participants from low-resource settings.

Methods: This was a prospective observational study analyzing the International Council of Cardiovascular Prevention and Rehabilitation's International CR Registry. Programs with annual assessment data at the time of study were included, and their characteristics were assessed in a survey. Self and program-reported patient morbidity included all- and cardiac-cause hospitalization, emergency department visits, cardiovascular disease events, and procedures 1 year from initial assessment. A multilevel modified Poisson regression model was used to account for clustering of patients within CR programs, estimating the adjusted incidence rate ratios (IRR) for morbidity.

Results: Of the 690 patients from programs in 6 countries across 4 regions (Colombia, Iran, Malaysia, Mexico, Pakistan, and Qatar), 637 (92%) were retained, of which 479 (75%) had morbidity data. Seven patients died and 93 suffered morbidity; this was most commonly noncardiac hospitalization (29 events) and emergency department visits (18 events). The regression analysis revealed a significantly lower incidence of morbidity associated with the following program factors: higher number of risk factors assessed (IRR = 0.55: 95% CI, 0.39-0.77), greater number of CR health care professionals (IRR = 0.76: 95% CI, 0.65-0.89), and CR located in academic/tertiary care institution (IRR = 0.61: 95% CI, 0.50-0.75).

Conclusion: Globally, CR programs could benefit from prioritizing comprehensive risk assessment and strengthening CR teams to potentially reduce morbidity.

Purpose: Cardiac rehabilitation (CR) could be an important opportunity for optimization of guideline-directed medical therapies (GDMT) for patients with heart failure with reduced ejection fraction (HFrEF). We set out to describe GDMT prescribing among enrollees in CR with HFrEF.

Methods: We queried the electronic health record of an academic medical center and identified patients with HFrEF who attended CR between 2016 and 2023. We defined CR cycles as at least 6 CR sessions with fewer than 6 months between sessions. Using a validated algorithm, we generated medication optimization scores (MOS, 0%-100% optimized) at the first and final CR session. The algorithm's input included GDMT, New York Heart Association classification, systolic blood pressure, heart rate, creatinine, potassium, allergies, and race. Wilcoxon Signed-Rank analysis was used to compare MOS.

Results: A total of 172 CR cycles were completed by 152 patients (64% male, 78% White, 67.5 ± 12.1 years old). Mean sessions per CR cycle was 26.4 ± 10.6. At the end of CR, 85 (49%) patients were on a beta-blocker, 84 (49%) a renin-angiotensin-aldosterone inhibitor, and 31 (18%) a mineralocorticoid receptor antagonist. Accounting for contraindications, patients were eligible for initiation or uptitration of at least 1 GDMT class after 84% of cycles. Median MOS at the start of CR was 39% (IQR: 14, 57) and 35% (IQR: 14, 57) at the end of CR ( P = .90).

Conclusion: GDMT utilization among patients with HFrEF in CR is suboptimal. There is a substantial opportunity to develop and validate strategies to improve GDMT prescribing during CR.

Purpose: Chronic obstructive pulmonary disease (COPD) is characterized by respiratory symptoms and problems, but it may also cause mild cognitive impairment in patients. The purpose of this systematic review is to investigate the effect of pulmonary rehabilitation (PR) on cognition in patients with COPD.

Review methods: A comprehensive literature search of 4 databases, including PubMed, Google Scholar, Science Direct, and Web of Science from inception to April 2024 was conducted. The review included studies investigating the effect of PR on cognition in patients with COPD. Two reviewers independently examined the titles and abstracts and extracted the data using a standardized form.

Summary: Our systematic review included 10 studies comprising 346 patients with COPD and 190 controls. Results provide evidence that PR may have an effect on cognitive function in patients with COPD, particularly when combined with cognitive training. However, the heterogeneity of study designs and outcomes underscores the need for further research to better understand the mechanisms underlying these effects and to inform the development of effective interventions for improving cognitive function in patients with COPD.

Purpose: Cardiac rehabilitation (CR) is an effective but underused secondary prevention strategy. We evaluated where the relative gap in the implementation of CR occurs and characteristics related to CR utilization.

Methods: We analyzed electronic health records from a large academic health system (2017-2019). We included patients aged ≥18 years, hospitalized with a cardiac event, with an indication for CR. We evaluated crude proportions and used mixed-effects logistic regression to examine the association of characteristics with referral, enrollment (≥1 session), and completion (≥36 sessions), accounting for multiple admissions.

Results: Among 4084 patient encounters (mean age: 65.3 ± 14.6 years, 45% female, and 42% Black), 25% were referred, 29% of those referred, enrolled, and 21% of those enrolled, completed CR. We identified characteristics associated with lower CR referral, for example, Black patients (OR = 0.64: 95% CI, 0.50-0.80), female patients (OR = 0.68: 95% CI, 0.56-0.83), and discharge from noncardiology services (eg, OR = 0.07: 95% CI, 0.05-0.10 for general medicine). Post-discharge outpatient visits were associated with higher CR referrals (eg, OR = 1.94: 95% CI, 1.56-2.41 for cardiology follow-up visits). The pattern was largely similar for enrollment and completion, except for higher enrollment for cardiac surgery and lower enrollment for lower-income patients.

Conclusions: In the CR care cascade, significant bottlenecks exist at each step, with the narrowest bottleneck noted at the completion stage. We also identified demographic and health system characteristics related to lower CR utilization, which can guide system- and individual-level efforts to promote CR use.