bluuebunny/crossref_metadata_2025 huggingface dataset:
Cardiac Rehabilitation during COVID-19
Authors: Desira C , De Gray G , Fleri Soler J , Abela M
Published: May 2022

Funding Acknowledgements

Type of funding sources: None.

Introduction

The 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 Objectives

The 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.

Methodology

Patients 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.

Results

710 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.

Conclusion

The 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.
Efficacy of remotely monitored cardiac rehabilitation in patients after cancer treatment: A pilot study
Authors: Batalik L , Filakova K , Dosbaba F , Pepera G , Papathanasiou J , Felsoci M , Janikova A
Published: May 2022

Funding Acknowledgements

Type of funding sources: Public hospital(s). Main funding source(s): This research was funded by the Ministry of Health, Czech Republic; conceptual development of research organization (FNBr, 65269705).

Background

Cardiovascular diseases are usually a partial cause of mortality in patients after cancer treatment. The increased cardiovascular risk in cancer patients is obtained from the cumulation of risk factors and the side effects of anticancer therapy. A multimodal model of cardiac rehabilitation (CR) can improve cardiorespiratory fitness (CRF), cardiovascular risk, and prognosis in this population. Despite the benefits of CR, patient participation in CR programs is very low. One of the main reasons for the low utilization and completion is the geographical distance from a specialized CR center. The remotely monitored CR method can solve a fundamental barrier that prevents CR programs' extensive and effective use.

Purpose

To examine the feasibility of remotely monitored CR as an alternative approach in hemato-oncological patients after cancer treatment. We assumed that the 12 weeks of remotely monitored CR would be feasible and improve the CRF.

Methods

From March to September 2021, a 12-week study of remotely monitored CR was performed in hemato-oncology patients after cancer treatment. The intervention was based on the principles of phase II CR and consisted of standardized exercise-based in a home-based model with regular telemonitoring and remote supervision. After a cardiovascular assessment, echocardiogram, troponin, brain natriuretic peptides, cardiopulmonary exercise test-CRF were examined, patients were instructed to perform prescribed exercise 3 times per week, for 30 - 50 minutes, at the target heart rate (HR) zone (70 - 90% HRmax) determined by baseline cardiopulmonary exercise testing. Patients were instructed to record their exercise training intensity using a HR monitor and the Borg scale (level 12 - 14 out of 20).

Results

Eight hemato-oncological patients (50% males; mean age 59.4 ± 12.0 years) enrolled in a remotely monitored CR program. All patients were post-cancer treatment, including cancer systemic chemotherapy-based treatment with recommended supportive care. The analysis showed a statistically significant increase in CRF by 13.7% (∆ 20.5 watts, p < 0.05, Abstract Figure). Overall training adherence was high (33.25 / 36 sessions). No exercise-related adverse events were recorded.

Conclusions

The pilot study results support the feasibility assumption of remotely monitored CR in hemato-oncological patients after cancer treatment. CR could lead to significant improvements in CRF. The study results can be useful for sample size estimation of future controlled studies to explore more significant evidence in this area.
Resistance training during cardiac rehabilitation improves physical performance in patients with coronary artery disease: a randomised controlled trial
Authors: Kambic T , Hadzic V , Sarabon N , Lainscak M
Published: May 2022

Funding Acknowledgements

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Slovenian Research Agency

Background

Resistance training (RT) is an adjunct exercise therapy to aerobic training (AT) in cardiac rehabilitation, but it remains unknown whether the dose-dependent relationship between RT load (high load [HL] vs. low load [LL]) and improvement in anthropometry, body composition and physical performance exists in patients with coronary artery disease (CAD).

Purpose

The aim of our study was to investigate the effects of HL-RT and LL-RT on top of AT in comparison to AT on anthropometry, body composition and physical performance in patients with CAD.

Methods

A total of 79 patients with a stable CAD were randomised to HL-RT+AT (n = 21), LL-RT+AT (n = 19) or AT (n = 19) and performed 36 training sessions. Fifty-nine patients with mean (SD) age 61 (8) years and left ventricular ejection fraction 53 (9) % completed the study. AT progressed from 50 % to 80% of peak power output achieved at baseline cardiopulmonary exercise test, and RT progressed from 70% of one repetition maximum (1-RM) to 80% of 1-RM in HL-RT group, and from 35% of 1-RM to 40% of 1-RM in LL-RT group. We measured anthropometry (body mass, waist and hip circumference, and waist to hip circumference ratio), body composition (lean body mass and %, body fat mass and %, and phase angle) and physical performance evaluating upper muscle strength (arm curl and hand grip test) and lower muscle strength (five sit-to stand test, up-and-go test, heel raise test), mobility (gait speed test), flexibility (back scratch test, sit-and-reach test), balance (stork balance test) and submaximal endurance (6 min walk test distance) at baseline and post-training.

Results

Waist circumference and waist-to-hip circumference ratio decreased significantly following LL-RT (both p < 0.01), without post-training differences between training interventions in other anthropometry measures and body composition measures (all p > 0.079). HL-RT and LL-RT induced improvements in all physical performance measures, while AT alone did not improve gait speed, upper limb flexibility and performance of up-and-go test. HL-RT was associated with greater improvement in gait speed (+12 %, p =0.044), arm curl test (+13 %, p = 0.037) and time of Up-and-go test (+9 %, p <0.001) compared to AT group, while LL-RT improved more time of Up-and-Go test (+18 %, p < 0.001) and time of five sit-to-stands (+14 %, p = 0.016) compared to AT. There was no difference between HL-RT and LL-RT in post-training change of physical performance measures.

Conclusions

The addition of RT to AT is associated with greater improvements in submaximal muscle strength and mobility compared to AT and should be encouraged in future multimodal exercise-based cardiac rehabilitation.
Impact of a home-based cardiac rehabilitation program in heart failure during the COVID-19 pandemic
Authors: Schmidt C , Basilio PG , Magalhaes S , Alexandre A , Barreira A , Fernandes P , Ribeiro F , Santos M
Published: May 2022

Funding Acknowledgements

Type of funding sources: Other. Main funding source(s): This work was financially supported by the project POCI-01-0145-FEDER-030011, funded by FEDER, through COMPETE2020-POCI, and by national funds, through FCT/MCTES (PTDC/MEC-CAR/30011/2017). CIAFEL, UnIC and UMIB are supported by national funds through Fundação para a Ciência e Tecnologia, I.P. [(UIDB/00617/2020), (UIDB/00051/2020 and UIDP/00051/2020), and (UIDB/00215/2020 and UIDP/00215/2020), respectively]. CS received an individual grant from CAPES [BEX 0554/14-6].

Introduction

Cardiac rehabilitation (CR) is an evidence-based recommended treatment of heart failure (HF) patients. During the COVID-19 pandemic, the shutdown of CR centers was necessary to limit the infection risk among high-risk patients. The integration of a home-based CR (HBCR) program in CR units can help to improve the delivery of care and improve cardiovascular outcomes of HF patients.

Purpose

To assess the effectiveness of an HBCR program in HF patients.

Methods

This is a sub­study of the EXercise InTervention in Heart Failure trial (EXIT-HF), which include forty-nine HF patients (preserved and reduced ejection fraction). The HBCR program consisted in 12-week combined exercise program (60%-80% of peak oxygen consumption (VO2 peak)), 2 training sessions per week, for a total of 24 sessions. Patients performed 4 supervised training sessions and the remaining sessions at home. All patients performed a cardiopulmonary exercise test (VO2 peak), the 6-minute-walking test (6MWT), collected blood analysis (plasma NT-proBNP), and answered the Minnesota Living with Heart Failure Questionnaire.

Results

Forty-two patients (86%) complete at least 80% of prescribed training sessions (age: 61.1±12; FEVE: 37.1±10.8). The HBCR program improve VO2 peak from 18.3 to 20.1ml/kg/min (+1.8 ml/kg/min; 95%IC:1.4 to 2.4; p<0.001) and the walked distance at the 6MWT from 462 to 512 meters (+49 meters; 95%IC: 38 to 60; p<0.001). In addition, overall quality of life was improved (-13 points; 95%IC:-7.8 to -18.5; p<0.001), as well physical (-6.3 points; 95%IC:-3.5 to -9; p<0.001) and emotional dimension of quality of life (-2.8points ; 95%IC: -0.9 to -4.7; p=0.06). No significant change was found in NT-proBNP levels (820±1220 vs 674±903; p=0.285).

Conclusions

Our results showed that HBCR is feasible and can improve functional capacity and quality of life in HF patients.
Role of Integrated yoga like posture, breathing excercise, music, satvic diet and bhagwad geeta for quit smoking and cardiovascular prevention as compare to still active smokers
Authors: Sen N , Tanwar SONAL , Jain ASHOK , Sen NARESH , Kumar DEEPAK
Published: May 2022

Funding Acknowledgements

Type of funding sources: None.

Introduction

Coronary heart disease (CHD) is increasing in young individuals and female also in India due to smoking .The possible effect of smoking on endothelial function has long been revealed and also cause oxidative distress, negatively affects platelet function, fibrinolysis, inflammation and vasomotor function.

Aims & Objectives: Our study was performed to quit smoking for better cardiovascular prevention .

Methods

17655 pre-hypertensive and prediabetic enrolled during 2009- 2011 at different medical centers, male versus female 4: 1 (age 18-50 years), 10660 non-smokers and 6995 smokers at same smoking index. We categorized group A for Integrated yoga like posture, breathing exercise (Pranayama), music, sattvic diet and bhagwad geeta for quit smoking and Group B who were denied for spiritual vedic program. Session were perform with three cycles for 3 months and taken follow up after 5 & 10 years.

Results

Data suggest that quit smoking samples were found in integrated yoga group A, 88 % versus 15 % in normal group B. We compared data and found significant BP, HR, HRV reduction around 2.5 fold higher reduction in integrated yoga group quit smokers as compare to still smokers in normal group B with P value ( 0.002, 0.004, 0.003), 1.5 fold reduction of BMI in group A (p<0.005). Significant two fold decrease of incidence of diabetes type 2 and left ventricular diastolic dysfunction, improvement of treadmill METs value, 6 min walk and pulmonary vital capacity in integrated yoga group after 10 years of follow up. 38% risk reduction of acute myocardial injury and stroke found in integrated yoga quit smoking group A.

Conclusion

Smoking cessation is mandatory to reduce cardiovascular events. Integrated yoga is a master life style intervention for quit smoking without medical side effects in future.
Basic life support and automated external defibrillators in secondary schools
Authors: Abela M , Grech V , Sammut MA
Published: May 2022

Funding Acknowledgements

Type of funding sources: None.

Introduction

Sudden cardiac arrest is the leading cause of premature death. Effective cardiopulmonary resuscitation (CPR) and early defibrillation substantially improve survival rates. This has also been replicated in schools, with excellent outcome data in schools who advocated CPR certification together with the availability of onsite automated external defibrillator (AED). Most entities now encourage AED installation in schools.

Objectives

As a follow up to the BEAT-IT cardiac screening program performed across all secondary schools in 2017/2018, the main aim of this study was to evaluate the availability of AEDs in schools across the Maltese archipelago. Information on staff CPR certification was also evaluated.

Methodology

One school administrator in all secondary schools across Malta and Gozo (n=54) were asked to complete an online questionnaire. All data was kept anonymous. Data was tabulated. Categorical variables were presented as percentages. Statistical analysis was performed with SPSS v23.

Results

Most schools (n=40, 74.1%) complied, the majority from the northern harbour region (n=15, 37.5%). Student gender in most schools was mixed (n=23, 57.5%). Two schools (5%) reported a cardiac arrest in one of their pupils over the previous 10 years, one happening during school hours. A minority (n=3, 7.5%) strongly disagreed that preventing sudden cardiac death (SCD) in schools is important. Only 1 (2.5%) had never heard of an AED.

Some schools (n=3, 7.5%) did not have an AED on school premises. The majority had one AED (n=1, 75.0%). Most schools service their AED regularly (n=34, 94.4%). The majority had an AED only on one floor (n=35, 97.2%). Most AEDs were installed in easily accessible areas (n=35, 97.2%), yet the location was not subjected to a risk assessment prior to installation in a significant proportion (n=17, 47.2%). Defibrillators in a third of schools (n=11, 30.6%) were not close to sporting facilities, an area traditionally recognized as a high risk location.

Most schools do not organise onsite CPR certification courses (n=21, 52.5%). Some staff are certified in CPR (n=35, 87.5%), a fifth having more than 5 certified individuals (n=8, 20.0%). The majority have also undergone recertification (n=28, 70.0%). Most were strongly in favour of a systematic cardiac screening program in schools (n=28, 70.0%).

Conclusion

A significant proportion of schools have experienced a cardiac arrest in one of its pupils (5.0%), implying this is an important health concern. Yet some still disagree that SCD prevention in schools is important (7.5%). Despite the majority having an AED on site, a substantial proportion did not have a risk assessment prior to installation (47.2%). Only a small proportion of staff members are certified in CPR. Most schools do not organise on-site CPR courses (52.5%). More education and awareness about cardiac arrest in students and CPR certification is necessary.
Prevalence of exercise-induced arrhythmias in young athletes with fragmented QRS pattern in lead V1
Authors: Quinto G , Vecchiato M , Borasio N , Baioccato V , Gasperetti A , Battista F , Neunhaeuserer D , Ermolao A
Published: May 2022

Funding Acknowledgements

Type of funding sources: None.

Background

Resting 12-lead electrocardiogram (ECG) in apparently health athletes has specific pattern, typically associate to heart remodelling in response to regular exercise. (1,2) Moreover, these adaptations were correlated to typical ventricular arrhythmias, not associated with underlying cardiac abnormalities.(3) Recently, also fragmented QRS complex in lead V1 (fQRSV1), representing right ventricular (RV) activation, seems related to training-induced RV remodelling in athletes, where its prevalence is greater.(4)

Purpose

Evaluate presence of fQRSV1pattern at resting ECG in a population of young athletes and its relationship with training-associated structural heart adaptations and exercise-induced ventricular arrhythmias.

Methods

This study retrospectively enrolled subjects who consecutively undergo to annual pre-participation screening and also to transthoracic echocardiography assessment, from January 2015 to September 2020. For each participant, medical history, physical examination, resting ECG, maximal standardized exercise test and echocardiographic evaluation were collected. All ECG were reviewed by two independent physicians to evaluate fQRSV1 pattern.

Results

684 young athletes (mean age 14.87±1.96 years, 36% female) were included and the overall prevalence of fQRSV1was 27%. Figure 1 shows an example of fQRSV1 pattern. Principal subject characteristics and evaluations data are shown in Table 1. fQRSV1 subjects presented a significantly wider QRS interval (p=0.004) and lower heart rate at rest (p=0.001). Exercise workload expressed in METs and exercise duration were higher in subjects with fQRSV1 (p=0.002 and p=0.023, respectively). Echocardiographic data showed that subjects with fQRSV1differ in morphological and functional right ventricular (RV) characteristics, especially had a higher indexed RV end diastolic diameter (p=0.019) and higher TAPSE (p=0.013). Patients with fQRSV1did not show an increased occurrence of supraventricular or ventricular arrhythmias, regardless of morphology, neither for isolated nor for repetitive events.

Conclusion

Overall prevalence of fQRSV1 pattern in young athletes is comparable with the one studied in other population of adult athletes in previous studies. Adolescent athletes with fQRSV1 present structural heart characteristic that differ from subjects without this ECG pattern, especially in RV feature. No differences in prevalence of any type of exercise-induced arrhythmias was shown, especially in common ventricular arrhythmias consistent with origin from the right ventricular outflow tract, previously described in healthy athletes.
Right atrial function in veteran endurance athletes with paroxysmal atrial fibrillation
Authors: Sorensen E , Myrstad M , Oie E , Tveit A , Solberg MG , Aaronaes M
Published: May 2022

Funding Acknowledgements

Type of funding sources: Foundation. Main funding source(s): A PhD grant from the DAM foundation and a grant from the Raagholt foundation

Background

Prolonged endurance exercise increases the risk of atrial fibrillation (AF) in middle-aged and older men, but the pathophysiology of AF in otherwise healthy athletes remains elusive. High-intensity endurance exercise puts an extreme load on the right side of the heart and has been associated with a reduction in right atrial (RA) function immediately following exertion. Prolonged endurance exercise impacts long-term remodeling of the RA and might favor the development of arrhythmias. Despite this fact, data regarding RA structure and function in older veteran athletes with prolonged exposure to endurance exercise is scarce.

Purpose

To describe RA volumes and function assessed by strain in a large cohort of male veteran cross-country skiers with and without AF, compared with age-matched controls with and without AF.

Methods

A total of 302 study participants, veteran skiers with paroxysmal AF (n=62), veteran skiers without AF (n=89), and controls from a non-athletic population with (n=62) and without paroxysmal AF (n=89), underwent an echocardiographic examination in sinus rhythm to evaluate RA structure and function. The skiers were former participants in the annual 54-kilometer cross-country ski race Birkebeinerrennet regarded as one of the most challenging cross-country ski-races globally. We conducted a two-way between-groups analysis of variance to explore the main effects of athletic status, AF status, and the interaction between AF status and athletic status in echocardiographic parameters.

Results

The athletes (mean age 70.8±6.7 years) reported an average of 16 completed annual Birkebeinerrennet races and 40-50 years of regular endurance exercise. RA and right ventricular volumes were considerably larger in athletes. RA and right ventricular function assessed by right ventricular free wall longitudinal strain, RA reservoir, conduit, and contractile strain were similar between athletes and non-athletes. Both AF groups had larger RA volumes and lower RA strain values regardless of athletic status.

Conclusion

RA function was similar in veteran cross-country skiers and controls despite prolonged exposure to endurance exercise with significantly larger RA volumes among athletes. Individuals with AF had lower RA strain parameters than those without AF, regardless of athletic status. RA volumes were associated with both athletic and AF status, and cardiorespiratory fitness needs to be considered when evaluating RA volumes. These findings suggest RA strain to be more closely linked to AF than RA volumes in male veteran endurance athletes.
Structure, organization, and practical functioning of the sports cardiology center of the Nemocnice Agel Trinec Podlesi
Authors: Jiravska Godula B , Jiravsky O , Pesova P , Krausova D , Spacek R , Pleva M , Pirchala M , Taborska A , Zajicek P , Rulkova L , Sknouril L , Sovova E
Published: May 2022

Funding Acknowledgements

Type of funding sources: None.

Introduction

Cardiological care of athletes worldwide is focused on prevention of cardiovascular disease, diagnosis, and follow-up of abnormalities in preventive screening, and subsequent therapy of detected pathologies with risk assessment for sport. The Czech Society of Sports Medicine and the Czech Cardiology Society responded to this process by establishing sports cardiology centers in the early 2020s. The centers were established in Olomouc, with two centers in Prague and Trinec.

Structure and organization

The Trinec Centre of Sports Cardiology (CSK) is organized based on tribal doctors of the Cardiocentre of the Agel Třinec-Podlesí Hospital and external cardiological collaborators from Silesia and Moravia. These doctors are trained in sports cardiology.

The practical functioning of the center is based on gradual steps: A) The patient logs in to our way through the web interface, where the essential information and previous examinations are given. B) The center's coordinator will incorporate these input data, will ensure communication with the client, other necessary information or examination, and after consultation with cardiologists, who subspecialize in the subunits, will establish a treatment plan. C) The CSK nurse ensures the organizational aspects of the established procedure. D) After the follow-up examination, the client has a final consultation with the sports cardiologist, where the suitability or limitations for sport and other recommendations for dispensation are always indicated. See Figure 1.

Cohort of athletes

Retrospective analysis of athletes from 1/2020 - 10/2021: 71 athletes, 26.0 +/- 1.5 years (15-61), 10 females (16%)/61 males: sport type: Endurance 31%, Mixed 66%. Most common indication: 46% coming in for abnormal preparticipation screening. At the conclusion of the investigation, only two were ineligible for sport, 32 eligible with condition

Conclusion

Structured, well-organized, and high-quality cardiac care for athletes is the main focus of the centers' work. In addition, the vision of our center is to provide tertiary cardiac care for athletes to reduce the risk of health complications in athletes. Therefore, our department is targeting EAPC accreditation for a sports cardiology center.
Positive CMR findings are associated with polymorphic ventricle arrhythmias and ECG repolarization changes but not with exercises induced arrhythmias in competitive and non-competitive athletes
Authors: Penza M , Filomena D , Monosilio S , Birtolo L , Serdoz A , Lemme E , Squeo M , Mango R , Di Gioia G , Fedele F , Gualdi G , Spataro A , Pelliccia A , Di Giacinto B , Maestrini V
Published: May 2022

Funding Acknowledgements

Type of funding sources: None.

Background

Cardiac magnetic resonance (CMR) provides an effective contribution for the prevention of sudden cardiac death with its ability to provide accurate information on morpho-functional abnormalities and on myocardial tissue characterization. However, data on its utility in clinical scenario in the competitive athletes are limited to selected cohort of patients with complex arrhythmias.

Objective

To retrospectively analyze all the CMR performed at our center for evaluating the predictors of positive CMR findings in a large cohort of competitive and non-competitive athletes presenting with different clinical indications.

Methods

Over a period of 30 months all the CMR performed on athletes aged > 14 years and training for at least 5 hours per week at our Institutes were retrospectively recruited. The following data were also collected: medical history, ECG, echocardiography, exercise testing. CMR were categorized as "positive" or "negative" based on the presence or absence of late gadolinium enhancement (LGE, excluding RV insertion point) and/or morphological and/or functional abnormalities. Predictors of "positive" CMR were explored.

Results

503 CMR were recruited and the most frequent indications for CMR were: ventricular arrythmias (n= 213, 42%), ECG abnormalities (n= 140, 28%) followed by echocardiogram abnormalities, symptoms and family history (Figure A). 308 (61%) CMR were "negative" and 195 (39%) "positive" (Figure B). Uncommon ventricular arrythmias did not result associated with positive CMR (p= 0.43), while polymorphic ventricular beats are associated with positive CMR (p= 0.02). Among ECG abnormalities only T-waves inversion, particularly on lateral and infero-lateral leads, were associated with positive CMR (p= 0.04).

Conclusion

Ventricular arrhythmias represented the most common indication for require a CMR but in almost half the cases, the CMR was negative. Excises induced ventricular arrhythmias is not significantly associated with pathological findings on CMR, while the polymorphic morphology of arrhythmias and the presence of lateral and infero-lateral repolarization abnormalities on ECG were associated with positive CMR.
Gender bias in the primary prevention of cardiovascular disease
Authors: Kang H , Tillmann T , Morrison J
Published: May 2022

Funding Acknowledgements

Type of funding sources: None.

Background/introduction

Women receive less aggressive treatment for cardiovascular disease (CVD), partly due to a delayed or incorrect diagnosis. However, there is little research into whether this gender bias extends to primary prevention of CVD (i.e. prevention of CVD in those individuals with no prior CVD events), and the reasons behind this bias.

Purpose

This study analysed gender differences in the primary prevention of CVD in the USA, using data from the National Health and Nutrition Examination Survey (NHANES) for the years 2015-2018. It also explored the drivers behind these differences. The hypothesis was that the known gender bias in CVD treatment also extends to primary prevention.

Methods

The risk of developing CVD over the next ten years was calculated using the Pooled Cohort Equations (PCEs) for 9,623 healthy men and women aged 40 to 79 years. 3,035 participants were found to be at higher CVD risk (ASCVD score above 7.5%) and potentially eligible for statins. Individuals with prior diagnosis of CVD were excluded from this study. Multivariable logistic regression was used to calculate adjusted odds ratios (AOR) in the usage of preventive treatment between genders.

Results

The results showed that men were 21% more likely to be prescribed statins than women whilst women were 20-37% more likely to be told to make behaviour modifications than men (Table 1). An interdisciplinary literature review showed that lower CVD risk perception in women is a likely driver of this gender difference.

Conclusion

The well-known gender bias in the treatment of CVD also appears to take place in the primary prevention of CVD with statin therapy. These findings have highlighted the gender bias in primary prevention of CVD, supporting the scarce existing literature on this topic and providing more recent evidence in line with the updated CVD prevention guidance. This has implications in developing interventions based in the health system and community context to improve the treatment and survival outcomes for women with CVD.
Cardiovascular disease after COVID-19 infection in elderly patients. Results of annual follow-up of a cohort of survivors
Authors: Aguila Gordo D , Piqueras Flores J , Martinez Del Rio J , Negreira Caamano M , Mateo Gomez C , Soto Perez M , Cubides Novoa AF , Moron Alguacil A , Munoz Garcia M , Blanco Lopez E , Soto Martin P , Salas Bravo D , Arizon Munoz JM
Published: May 2022

Funding Acknowledgements

Type of funding sources: None.

Introduction

Although the effects of SARS-CoV-2 infection on the cardiovascular system are well known in the acute phase, the cardiovascular impact in the elderly population surviving respiratory COVID-19 infection after 1-year follow-up has not been sufficiently studied.

Methods

Observational registry of 240 elderly patients (75 years or older) consecutively admitted for and surviving COVID-19 respiratory infection between March 1 and April 30, 2020. The incidence of major cardiovascular events [MACE] (cardiovascular death [CD], acute coronary syndrome [ACS], cerebrovascular disease [CVD], venous thromboembolic disease [VTE], and heart failure [HF]) was prospectively analyzed.

Results

The mean age was 83.8 ± 5.6 years (range 75-103 years). A total of 54.2% were women. Most patients had a personal history of cardiovascular risk factors: hypertension (83.3%), diabetes mellitus (27.9%), dyslipidemia (43.8%). Among the main cardiological comorbidities, a history of atrial fibrillation was the most frequent (18.8%). Of note was the high percentage of institutionalized patients (37.1%) and those with moderate-severe dementia (16.7%). After a mean follow-up of 352.2±70.4 days, 13.8% of patients died and 9.6% had MACE, the most frequent being heart failure (7.5%), with no differences in the severity or overall evolution of the acute disease. Of the 33 patients who developed HF, only 3 died of cardiovascular causes. Only 2 patients suffered a stroke, in both cases without a history of AF or anticoagulants. Only 2 patients had a thromboembolic event (0.8%). The low incidence of thrombotic events may be due in part to the high rate of anticoagulation and chronic antiplatelet therapy and the high percentage of prophylactic heparin prescription at discharge, as well as the fact that only cases with clinical repercussions. COPD, CKD, institutionalization and moderate-severe dementia are associated with an increased risk of MACE, although only COPD and prescription of loop diuretics were identified as independent risk markers in the multivariate analysis.

Conclusions

In elderly COVID-19 survivors, the incidence of MACE after one year of follow-up is high, the main manifestation being heart failure. COPD and the prescription of loop diuretics were identified as independent risk markers for the development of MACE in the multivariate analysis.
Impact of a new and remote diagnosis of heart disease on exercise behavior in older adults
Authors: Cahalin L , Garber C , Burr J , Caro F
Published: May 2022

Funding Acknowledgements

Type of funding sources: None.

Background/Introduction

Exercise is an important factor in the primary and secondary prevention of heart disease. However, few data are available on predictors of exercise in older adults, especially the impact of a new and remote diagnosis of heart disease (NHDD and RHDD, respectively) on exercise behavior. It is possible that the motivational impact of a NHDD may be more powerful than a RHDD in promoting exercise in older persons.

Purpose

The purpose of this study was to examine predictors of exercise in older adults using the Health and Retirement Survey (HRS), a prospective, nationally representative household survey examining retirement and health among older persons in the United States that is repeated every two years. We hypothesized that older persons with a NHDD and RHDD will be more likely to exercise.

Methods

Data from respondents who were age 55 or older in 1998 were grouped using three waves of the HRS (1998, 2000, and 2002) which provided three distinct person-wave observations for each respondent, yielding 38,634 respondent person-wave observations (9,629 with RHDD and 1,689 with NHDD) with a mean age of 70±9 years (55% female). Logistic regression models were developed to examine the predictors of exercise while controlling for a variety of demographic and health related variables.

Results

A NHDD was the strongest positive predictor (odds ratio=1.195, p<0.01; 95% CI=1.054-1.355) while a RHDD was not a significant predictor of exercise in older adults (odds ratio=1.034, p=0.31; 95% CI=.969-1.105). No significant difference in demographic, co-morbid conditions, or perceived health was observed between older adults with a NHDD and RHDD.

Conclusions

A NHDD was a strong positive predictor of exercise in older adults. A RHDD was not a significant predictor of exercise, suggesting that the motivation impact of a heart disease diagnosis lessens over time and secondary prevention efforts such as cardiac rehabilitation continue to be of importance. Long-term programming for maintenance of exercise in older persons with a RHDD appears to be particularly important and requires further investigation.
Very acute benefits on physical performance in elderly patients who undergone TAVI
Authors: Cunha NPD , Alves Da Silva P , Garcia B , Pinto R , Gregorio C , Fonseca J , Brito J , Pinto F J , Abreu A
Published: May 2022

Funding Acknowledgements

Type of funding sources: None.

Introduction

Transcatheter aortic valve implantation (TAVI) emerged as a safe and efficient procedure in patients with high or prohibitive surgical risk or in older patients. The prevalence of severe aortic stenosis is growing up, given de aging of population. These patients are much often frailty and experience low levels of physical activity and functional capacity as a result of their aortic valve disease and comorbidities. When untreated severe aortic stenosis has a poor prognosis so it is of utmost importance to restore the normal hemodynamic condition and consequently to improve functional capacity.

Aim

To assess the acute benefits (in 1 moth) of TAVI on functional capacity and physical performance.

Methods

Single center prospective study of patients submitted to TAVi between April 2021 and September 2021. Patients were evaluated at baseline (before TAVI) and one month after the procedure. To assess physical activity and functional capacity it was used the International Physical Activity Questionnaire (IPAQ) and the short physical performance battery (SPPB) which is a group of measures that combines the results of the gait speed (two timed trials of a 4-m walk – fastest recorded), chair stand (time to raise for a chair 5 times) and balance tests (ability to stand for 10 seconds with feet in 3 different positions). Additionally, patients were submitted to handgrip strength test. Paired sample t-test and Wilcoxon test were used to statistical analysis.

Results

We included 20 patients, with a mean age of 85±5,86 years, 40% (8) male. 19 patients undergone TAVI due severe native aortic stenosis and 1 due to bioprosthetic aortic valve dysfunction. The vascular access site was transfemoral in 19 patients and transapical in 1 patient.

No patient had vigorous physical activity either before or after TAVI, but the daily sitting time was lower after the procedure (mean time: 634 versus 570 minutes), however not statistically significant. Regarding the results of SPPB patients experience improvements in balance (p=0,035) and chair stand (time to raise for a chair 5 times: 19,04 versus 17,05 seconds), p=0,01.

Patients tended to be faster in 4m velocity test, however with no statistical difference (8,49 versus 6,6 seconds). No statistical differences were also observed in handgrip strength test.

Conclusion

In an elderly population, TAVI appears to have an early and beneficial effect (in 1 moth) on some domains oh physical activity and functional capacity.
L-carnitine supplementation decreases insulin resistance, c-reactive protein in patients with chronic coronary artery disease and prostate adenocarcinoma
Authors: Sirenko O , Ossenyi I , Krasnov V
Published: May 2022

Funding Acknowledgements

Type of funding sources: None.

The aim of the study was to evaluate the effect of L-Carnitine on the inflammation, insulin resistance (IR) in the complex therapy of patients with coronary heart disease end prostate adenocarcinoma.

Materials and methods

42 men with prostate adenocarcinoma and chronic coronary heart disease (CAD) were enrolled. The patients were randomly and blindly divided into 2 groups: Group I patients were treated with L-Carnitine in addition to standard treatment; Group II patients received only conventional treatment. Standard laboratory blood tests, lipid profile, glucose, renal and liver function tests, serum C-reactive protein (CRP), insulin, echocardiographic examination were performed for all patients as baseline and after 10 days of treatment.

Results

IR was established in 54.8% patients of Group I and 40% patients of control group (p<0.05). In the Group I median level of HOMA index was 3.1 [1.9; 4.8] mg/ml, CRP - 10.3 [5.2; 11.1] mg/ml and decreased by 15.4% (p = 0.001) and 19.2% (p = 0.003), respectively. The supplementation of L-Carnitine in standard therapy contributed to a significant decrease in serum creatinine level and an increase in the level of GFR in Group I patients (p <0.05).

Conclusion

The supplementatiıon of L-Carnitine in patients with chronic coronary artery disease and prostate adenocarcinoma contributes to a significant decrease in insulin resistance, C-reactive protein level.
Accuracy of photoplethysmography-based measurement of blood pressure
Authors: Falter M , Driesen K , Scherrenberg M , Pieters Z , Kaihara T , Dendale P
Published: May 2022

Funding Acknowledgements

Type of funding sources: None.

Introduction

Photoplethysmography (PPG)-based blood pressure (BP) measurements are available in the latest smartwatches and are thus available for patients in the consumer market. While the devices typically comply with the medical device regulation, accuracy is often not known and data on validation are not publicly available.

Purpose

To investigate the accuracy and precision of the Samsung Galaxy Watch Active 2 PPG-based BP measurement as compared to conventional BP measurement and to investigate clinical applicability.

Methods

31 patients scheduled for ambulatory 24-hour BP measurement were included in the study. 24-hour BP devices were attached to the non-dominant arm, smartwatches were attached to the opposite arm. Calibration was performed as instructed by the manufacturer. The smartwatch was used to register BP intermittently for 24 hours. Results from both devices were compared using the Taffé method.

Results and discussion

Mean age was 59 years. 17 patients (55%) were male. Comparison of the two methods is demonstrated in Figure 1. The smartwatch overestimates the systolic BP up to approximately 132 mm Hg and then underestimates the systolic BP, illustrating the presence of proportional (0.48) and differential (69.0) bias. Precision for the gold standard method was higher compared to the smartwatch measurements. For increasing values of systolic BP, the precision of the smartwatch decreases. For diastolic BP, differential (31.4) and proportional bias (0.68) are present, resulting in an overestimation of the diastolic BP at lower values (<100 mmHg). Precision for the gold standard method was higher at lower BP values, while precision for smartwatch measurements was higher at higher BP values (i.e. there was a lower standard deviation of measurement error).

Figure 1

Bias and precision plots for systolic and diastolic blood pressure (BP).

In each figure the x-axis indicates the best linear unbiased prediction (BLUP) or true value of BP. Panel A and B indicate the bias plots. Smartwatch measurements (blue dashed lines) are compared to reference measurements (solid black line); both values are read from the leftmost y-axis. The bias (difference of smartwatch measurement compared to the reference method) is depicted as a solid red line; the value of bias is read from the rightmost y-axis. Panel C and D indicate the precision plots, indicating the standard deviation of measurement errors for both measurement methods. The reference method is depicted in black; the smartwatch method is depicted in blue.

Conclusion

There is a differential and proportional bias in PPG-based BP measurement of systolic and diastolic BP measurement. The systolic BP is overestimated at lower values and underestimated at higher values. This might indicate potential for application as a screening tool for hypertension. Further research is needed to investigate clinical applicability.
Effect of complex weight-reducing interventions on rhythm control in obese individuals with atrial fibrillation following catheter ablation (HOBIT-AF)
Authors: Stolbova K , Kautzner J , Haluzik M , Jakubikova I
Published: May 2022

Funding Acknowledgements

Type of funding sources: None.

Introduction

HOBIT-AF is a single-blinded, parallel-group randomised controlled trial with 18-month follow-up to assess the effect of complex weight-reducing interventions supported by the use of smart technologies on the arrhythmia burden in obese individuals following catheter ablation for atrial fibrillation. Participants in the intervention group will be provided with a smartphone and smartwatch at month 3 visit for the rest of the trial and the participants in the control group at month 9 visit for the rest of the trial. A purpose-made mobile application will be pre-installed on smartphone. This application will enable participants to generate an ECG report twice a day and in case of an arrhythmia episode. Participants will be asked to regularly provide their weight, blood pressure and physical activity, and these data, together with heart rate, ECG trace and steps count will be securely transferred to investigators at the local home-monitoring centre. Besides, a custom-made website was designed for the participants of the trial containing useful tips concerning nutrition, cooking tips and physical activities.

Purpose

The effect of complex weight-reducing interventions on the arrhytmia burden and quality of life.

Methods

One hundred and sixty individuals (age 18–70 years, body mass index ≥ 30 kg/m2) will be randomised in a 1:1 fashion to undergo a structured weight reduction programme aiming to achieve greater than 10% weight reduction from baseline (intervention group) or standard post-ablation medical care (control group).

Results

Until 30th September 2021, 31 people were randomized to the intervention group (5 people resigned) and 34 people to the control group (1 person resigned).

Since the start of the study, patients in the intervention group reduced their body weight by 5% so far, and most of them (73%) still have 9 months of active intervention to go. Participants in the control group gained on weight an avarage of of 1.6% over the reference period (39% of those surveyed in month 9).

Conclusion

This trial will employ smart technologies to increase the motivation and adherence to introduced lifestyle changes.
TeleDiet study: A randomised controlled study investigating the impact of smartphone-supported dietary education and counselling on secondary prevention of coronary heart disease
Authors: Kaihara T , Falter M , Scherrenberg M , Maes J , Meesen E , Dendale P
Published: May 2022

Funding Acknowledgements

Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Daiichi Sankyo

Introduction

Dietary habits are a key factor influencing cardiovascular risk and its progression. Dietary counselling as part of current cardiac rehabilitation programmes has certain limitations: it is often intermittent with a delay between feedback on nutritional intake and reassessment by the dieticians. Digital technology could offer a solution.

Purpose

The purpose of this study was to investigate the impact of smartphone-supported feedback on dietary pattern and outcomes in a population with coronary heart disease (CHD).

Methods

Of 129 successive patients with CHD, 16 patients who agreed to participate in the study were randomised to either a TeleDiet group or a control group. Patients in the TeleDiet group participated in smartphone-supported diet education in addition to usual in-person education by dietitians. The patients were asked to take pictures of their meals and send them to dietitians using a messaging application. The dietitians then sent them feedback about their diet. The patients in the control group received the usual education only. The primary outcome was the change of Mediterranean Diet score (MedDiet score) between the two groups during three months. The secondary outcomes were the estimate of self-efficacy, medication adherence, and heart-related quality of life (the change of the General Self-Efficacy Scale [GSES], the Identification of Medication Adherence Barriers Questionnaire [IMAB-Q], and the HeartQoL). A total of 14 patients were included in the analysis.

Results

As a whole, 113 patients did not participate in the study. The most common reason of rejection was "no interest in the study" and the second one was "unable to use a smartphone". Table 1 showed the characteristics of the 14 patients separated into two groups: the TeleDiet group (n = 6) and the control group (n = 8). There was no difference of baseline characteristics between the two groups. The changes of the MedDiet score were not significantly different between the TeleDiet group and the control group (2.0 ± 4.5 vs. 1.3 ± 5.2, p = 0.783). In terms of the secondary outcomes, there were no significant differences between the two groups (Table 2). There were no significant differences of these outcomes in within-group analysis, neither.

Conclusion

Using a smartphone application is a hurdle for CHD patients at the moment, and these preliminary results do not show a benefit of dietary intervention with mobile health. These are the intermediate results of the whole TeleDiet study, and the study should be expanded to a larger population.