International Journal of Cardiology Cardiovascular Risk and Prevention最新文献

Introduction

The positive effect of cardiac rehabilitation (CR) is demonstrated in younger and older patients. However, it is quite debated whether the beneficial effect is similarly maintained in both genders during follow-up.

Aim

to determine if the improvement obtained after CR remained significant at 1-year follow-up in older population, testing the influence of gender on this outcome.

Methods

All patients aged 75+ years consecutively referred to Cardiac Rehabilitation outpatient Unit at Careggi University Hospital were screened for eligibility. All patients attended a CR program, based on 5-day-per-week aerobic training sessions for 4 weeks and they were evaluated at the end of CR at 6 and 12 months of follow-up.

Results

361 patients with a mean age 80.6 ± 4.4 years with a complete 1-year follow-up were enrolled in the study, 87.5 % of them had an acute coronary event, and 27.6 % were females. The increase in exercise capacity at the end of CR and at 1-year follow-up was statistically significant (VO2 peak: +8.7 % in males p < 0.001, +8.5 % in females p < 0.001; distance walked at 6-min test: +7.3 % in males p < 0.001, +10.2 % in females p < 0.001, respectively); the trajectory of exercise improvement at 6 and 12 months of FU was similar in men and women without significant decrease (VO2 peak-ml/kg/min: CR discharge vs 1 year FU = 15.2 vs 15,0 p: NS; distance walked-meters: CR discharge vs 1 year FU = 445.5 vs 440.6, p: NS) from end of CR to 1-year.

Conclusions

the improvement in exercise tolerance obtained with CR program is still maintained at 1-year FU without significant influence of gender in our very old population.

Background

Framingham risk score (FRS) and Atherosclerotic Cardiovascular Disease risk score (ASCVDrs) are widely used tools developed based on the American population. This study aimed to compare the ASCVDrs and FRS in an Iranian population.

Method

The participants of the Fasa Adult Cohort Study and the patients of the cardiovascular database of Vali-Asr Hospital of Fasa, aged 40–80 years, were involved in the present cross-sectional study. After excluding non-eligible participants, the individuals with a history of myocardial infarction or admission to the cardiology ward due to heart failure were considered high-risk, and the others were considered low-risk. The discriminative ability of FRS and ASCVDrs was evaluated and compared using receiver operating characteristic curve analysis. The correlation and agreement of ASCVDrs and FRS were tested using Cohen Kappa and Spearman.

Results

Finally, 8983 individuals (mean age:53.9 ± 9.5 y, 49.2 % male), including 1827 high-risk participants, entered the study. ASCVDrs detected a greater portion of participants as high-risk in comparison with FRS (28.7 % vs. 15.7 %). ASVD (AUC:0.794) had a higher discriminative ability than FRS (AUC:0.746), and both showed better discrimination in women. Optimal cut-off points for both ASCVDrs (4.36 %) and FRS (9.05 %) were lower than the original ones and in men. Compared to FRS, ASCVDrs had a higher sensitivity (79.3 % vs. 71.6 %) and lower specificity (64.5 % vs. 65.1 %). FRS and ASCVDrs had a moderate agreement (kappa:0.593,p-value<0.001) and were significantly correlated (Spearman:0.772,p-value<0.001).

Conclusions

ASCVDrs had a more accurate prediction of cardiovascular events and identified a larger number of people as high-risk in the Iranian population.

The Italian Association for Cardiovascular Rehabilitation and Prevention (ITACARE-P) and the Italian Federation of Associations of Hospital Doctors on Internal Medicine (FADOI) released a joint position paper to guide referrals of cardiovascular patients discharged from Internal Medicine (IM) wards to Cardiac Rehabilitation (CR) facilities. The document provides rationale and operative recommendations for appropriateness (i.e. qualifying diagnoses) and priority criteria to overcome the mismatch between potential demand and effective supply of CR programmes. In case of no-referral due to logistic barriers, the document recommends the adoption of best alternatives to CR for disability reduction, better prognosis, and improvement of quality of life. The joint position paper is also aimed to promote the consideration of IM as a potential stakeholder of CR.

Women receive similar or greater benefits than men from Cardiac Rehabilitation (CR). However, they are less likely to participate. An integrated and gender-sensitive approach to cardiovascular disease is required to enhance the quality and experience of care for women with different cardiovascular issues throughout their lives.

The Italian Alliance for Cardiovascular Rehabilitation and Prevention (ITACARE-P) is committed to developing a gender-specific approach to CR that will more effectively meet the needs of both women and men.

Background

The prevalence and incidence of cardiovascular diseases significantly increase with age, and it is well-known that nutritional status affects the prognosis and treatment of these diseases. Therefore, evaluating nutritional status is essential for maintaining/regaining health. It is crucial to identify nutritional risk early, prevent and/or treat protein-energy malnutrition, and promote the modification of inappropriate dietary habits.

Methods

Nutritional screening represents the first step of access to the Nutrition Care Process (NCP) adopted and managed by the dietitian; this tool must be simple, inexpensive, accessible, accurate, efficient, and validated. A globally accepted standardized definition of malnutrition is necessary, and for this reason, the Global Leadership Initiative on Malnutrition (GLIM) criteria have been recently introduced.

The GLIM criteria, after confirming nutritional risk through screening, include both phenotypic and etiological criteria: to diagnose malnutrition, at least one of these must be present.

A less commonly performed phenotypic criterion is the assessment of muscle mass, which should be studied as a significant component of sarcopenia.

Conclusion

Greater attention to the identification and treatment of malnutrition would bring benefits to patients and ensure a saving in healthcare expenditure, but for this purpose, an implementation of clinical nutrition services is necessary.

Cardiac amyloidosis is becoming increasingly important among cardiologist and an early diagnosis is very important. Amyloidosis is a systemic disease and many cardiac and extracardiac elements (red flags) should raise the suspicion of the disease. Electrocardiographic and imaging techniques (such as echocardiography, cardiac magnetic resonance and scintigraphy) are useful tools to make a diagnosis together with the presence of orthopedic issues, peripheral neuropathy or plasma cell dyscrasia. Cardiac amyloidosis is also often associated with valvular disorder, heart failure or cardiomyopathy. Red flags are crucial to raise suspicion and reach an early diagnosis, in order to start a targeted treatment strategy that could change the patient's outcome. Indeed, in the last years four new drugs were approved to treat transthyretin amyloidosis.