bluuebunny/crossref_metadata_2025 huggingface dataset:
Incorporating AI into cardiovascular diseases prevention - insights from Singapore
Authors: Dalakoti M , Wong S , Lee W , Lee J , Ngiam K Y , Foo R
Published: June 2024

Introduction

Improved upstream primary prevention of cardiovascular disease (CVD) would enable more individuals to lead lives free of CVD. However, there remain gaps in provision of CVD primary prevention, namely a) addressing social determinants of health in an equitable way and b) enabling convenient and accessible CVD primary prevention across the spectrum of primary to specialist care.

Methods

A battle map for CVD prevention- CardioSight.

Using the data informatics capabilities at the National University Health System (NUHS), Singapore, empowered by the Endeavour AI system, and combined large language model (LLM) tools, our team has created a real-time dashboard able to capture and showcase information on cardiovascular risk factors at both individual and geographical level- CardioSight. Being Streambased AI, the dashboard can interface in real time with our healthcare cluster’s Electronic Medical Records System (EMR) to achieve live data feeds for real time analysis and visualisation (Figure 1).

Real time data is pinned on a geographical heat map alongside nearest primary care providers, providing a battle map to target individuals at various levels of cardiovascular risk. Further insights such as medication records and data on area-level socioeconomic determinants allow a whole-of-systems approach to promote healthcare delivery, while also allowing for outcomes to be tracked effectively.

Results

Figure 2 shows the Glycated hemoglobin (HBA1c) and low-density lipoprotein- C (LDL-C) values of 93,200 patients with diabetes managed in NUHS from 1/6/23 to 31/10/23, mapped to where they live in Singapore. Light green spots represent HBA1c < 7, yellow spots represent HBA1c 7-10%, and red spots represent HBA1c > 10%. Diamonds represent LDL-C 1.8 to <= 2.6, up-pointing triangles represent LDL-C 2.6 to <= 3, and down-pointing triangles represent LDL-C > 3. 13,728 (14.7%) patients have concurrently HBA1c > 7% and LDL-C > 1.8.

Discussion

A significant proportion of the population of diabetics has risk factors not at target. There is also a geographical overrepresentation of some of these patients in certain areas. These would represent key groups and individuals to deliver preventive interventions.

Conclusion

In its complete form, CardioSight supports the execution of personalised yet high-level preventive cardiology initiatives within our healthcare system. Importantly, knowledge of baseline epidemiology of CVD and risk factors will allow assessment of the effectiveness of ongoing interventions over not just a geographical location but also across a timeline. Fig 1.NUHS AI Tribrid Architecture  Fig 2.Hba1c, LDL-C control in diabetics
Implementation and willingness-to-pay of a hybrid remote training programme in a population with obesity
Authors: Falter M , Kizilkilic E , Scherrenberg M , Tukanov E , Gerits M L , Marneffe W , Sinnaeve P R , Dendale P
Published: June 2024

Background/Introduction

Remote training has demonstrated effectiveness in multiple trials. Implementation trials are the next step to achieve this as standard of care.

Purpose

The pilot study is a next step in our centre’s road towards implementation of cardiac rehabilitation. It is performed in a relatively young, obese population without known cardiac disease. The primary aim of the study was to assess implementation parameters.

Methods

This is a single-arm implementation study in 45 patients in the setting of an on-site training programme. Patients received a FitBit Charge 5, step count and heart rate "zone minutes" goals and follow-up by a physiotherapist. The program consisted of 3 months of hybrid training and 3 months of remote training. A monthly 6-minute-walking-test (6MWT) was performed remotely by use of the patient’s smartphone.

Results and discussion

Results of the first 3 months (hybrid training) are discussed. Results are shown in Table 1. Overall, acceptance and satisfaction were favorable. 6MWT results are depicted in Figure 1. At Month 3, we observed a sustained beneficial effect on physical fitness.

Conclusion

Our hybrid training intervention was successfully implemented, with acceptable willingness to pay, and durable benefits in physical fitness and weight loss.
Impact of behavioral and social factors compared to conventional risk factors in the development of coronary artery disease in Switzerland: SWISSHEART
Authors: Durandi V E , Van Der Stouwe J G , Biniasch S , Djurdjevic A , Burkard T , Yuzuak B , Jordan F , Haegele M , Storni M , Pfister O
Published: June 2024

Background

Conventional risk factors for coronary artery disease (CAD) are well established and are key for cardiovascular prevention and risk stratification. In addition to conventional risk factors, behavioral and social factors may influence CAD risk, but their impact remains ill defined.

Purpose

To determine the impact of behavioral, social and conventional cardiovascular (CV) risk factors on CAD risk in Switzerland.

Methods

We used a 1:3 case-control design including 1776 individuals with CAD from the Swiss Secondary Prevention and Rehabilitation Registry (SwissPR,) and 5328 age- and sex-matched control subjects without established CAD from the Swiss National Health Survey. All individuals were recruited between January 2017 and September 2023. Data for conventional cardiovascular risk factors (arterial hypertension, diabetes mellitus, dyslipidemia, smoking status and BMI) were obtained from patient charts, patient history and questionnaires. Data for behavioral factors (dietary habits, alcohol consumption, physical activity) and social factors (marital status, children) were collected using standardized questionnaires. Odds ratios for the association of individual factors with CAD were calculated using univariate and multivariate logistic regression models.

Results

In average, patients were 62 years old, predominantly male (79%) and of European origin (99%). Among conventional risk factors dyslipidemia (OR 5.7; 95% CI, 5.02-6.47) showed the strongest independent association with CAD followed by arterial hypertension (OR 2.66; 95% CI, 2.34-3.03), diabetes mellitus (OR 1.95; 95% CI, 1.63-2.34) and a history of smoking (OR 1.57; 95% CI, 1.38-1.78). Among behavioral factors intense physical exercise (OR 0.75; 95% CI, 0.7-0.79) and regular alcohol consumption (OR 0.95; 95% CI, 0.91-0.98) were inversely associated with CAD but dietary habits including fish, meat, fruit and vegetable consumption had no independent association with CAD risk. Being single (OR 2.54; 95% CI, 1.79-3.59), divorced (OR 1.9; 95% CI, 1.42-2.51) or widowed (OR 1.66; 95% CI, 1.08-2.46) significantly increased the odds for CAD compared to being married but having children had no independent association with CAD.

Conclusion

These results establish a strong association between marital status with CAD and underpin the protective role of intense physical activity. Conventional CV risk factors remain the main drivers of CAD risk with dyslipidemia and arterial hypertension accounting for most of the risk.
Data mining insights: mapping patient journeys and guiding complementary test prescriptions in atrial fibrillation
Authors: Flores Soler J , Canadas-Godoy V , Garcia Gonzalez F , Llorente Sanz L , Luaces Mendez M , Bengoa Terrero C , Perez-Castellano N , Perez-Villacastin Dominguez J
Published: June 2024

Introduction

Atrial fibrillation (AF), a prevalent cardiac arrhythmia, often leads to an extensive array of complementary tests and treatments. While crucial for effective treatment, the frequent prescription of various complementary tests often leads to an excessive burden on healthcare resources, resulting in prolonged waiting times and potential mismanagement of patient care. Addressing this challenge necessitates a strategic approach to understanding and optimizing test prescriptions. Through the lens of data mining, to dissect these complexities in AF patient management. The study's objective is to employ data mining techniques to trace the trajectory of patients with atrial fibrillation and analyze the prescription of complementary tests across various departments of a tertiary hospital.

Methods

We employed advanced Big Data preprocessing, data mining, process mining, and business intelligence methods. Data was analysed from 2016 to 2020, including clinical and administrative records on hospital discharges, complex procedures, emergency care, and speciality practices. Patients with primary or secondary atrial fibrillation (AF) diagnosis were selected. Data from the Basic Minimum Set of Data (BMSD), encompassing discharge information and Cardiology outpatient resources was refined to remove inconsistencies and duplicates. We then streamlined this into smaller, more manageable subsets. Our focus was mapping AF patient trajectories between cardiology service (cardiology group) and other hospital services (others groups) and prescribed complementary tests (CT) like transthoracic and transesophageal echocardiograms (TTE and TEE, respectively), Holter electrocardiograms (H-ECG), and cardiac ablations, specifically, pulmonary vein isolation. Integrating these subsets and applying data transformation and reduction techniques created a unified dataset for in-depth analysis using process mining and business intelligence tools.

Result

After analyzing 71014 individual BMSD records, we quantified the visits to cardiology consultations, arrhythmia clinics, CT prescribed from cardiology services or not to perform TTE, Holter-ECG, and ablation from 10742 unique patients from 2016 to 2020: 28276 TTE and TEE were perform, 60,82% were prescribed from the other hospital services, the rest from cardiology; 6933 Holter ECG were prescribed, mostly from other services different than cardiology (67,7%) 2274 cardiac ablation were identified coming from other services 72,3%.

Conclusions

Most subjects involved in the AF patient journey and the Complementary tests prescribed come mainly from different services than cardiology. Healthcare strategies should involve other departments to improve results in terms of delays, health economics and clinical outcomes.
Predictors of worsening kidney function and their relation to SGLT2 inhibitor dapagliflozin administration in type 2 diabetes mellitus patients with chronic heart failure
Authors: Berezin A E , Lichtenauer M , Hoppe U , Berezina T A , Obradovic Z , Berezin O O
Published: June 2024

Background

Sodium-glucose cotransporter 2 inhibitors (SGLT2i) had a favorable impact on the kidney function in heart failure (HF) patients, while there is no clear evidence of what factors predict this effect. The aim of the study was to identify plausible predictors for kidney function outcome among HF patients and investigate their association with SGLT2i.

Methods

We prospectively enrolled 480 patients with established type 2 diabetes mellitus (T2DM) and concomitant chronic HF I-IV New York Heart Association functional classes and followed them for 52 weeks. In the study, we determined the kidney outcome as a composite of a sustained declined in estimated glomerular filtration rate by 40% from baseline, or newly end-stage of kidney disease, or kidney replacement therapy. The relevant medical information, measurement of the biomarkers (N-terminal natriuretic pro-peptide, irisin, apelin, adropin, C-reactive protein, tumor necrosis factor-alpha) were collected at baseline and at the end of the study.

Results

The composite kidney outcome was detected in 88 (18.3%) patients of entire population. Amongst these individuals, 51 patients demonstrated declined in eGFR by 40% from baseline at the end of the follow-up period, 35 individuals had newly diagnosed ESKD and consequently two patients required kidney replacement therapy (hemodialysis). All patients received guideline-recommended optimal therapy, which was adjusted to phenotype / severity of HF, CV risk and comorbidity profiles and fasting glycaemia. The changes of the biomarkers levels during the dapagliflosin administration are reported Figure 1. We used Received Operation Curve analysis to identify the well-balanced cut-off points for the biomarkers (Figure 2). The multivariate logistic regression revealed that use of SGLT2i (OP = 0.92; p = 0.048), baseline serum levels of irisin less 4.50 ng/mL (OR = 1.51; p = 0.001), adropin less 2.10 ng/mL (OR = 1.15; p = 0.001) along with increase in the levels of these biomarkers less 15% (OR = 1.60; p = 0.001) and less 6% (OR = 1.21; p = 0.001) respectively retained an independent predictor for composite kidney end-point. We noticed that irisin serum levels less 4.50 ng/mL at the baseline and the increase in irisin less 15% added more valuable predictive information than the reference variable. Yet, the combination of irisin less 4.50 ng/mL at the baseline and the increase in irisin serum levels less 15% (AUC = 0.91; 95% CI = 0.87–0.95) improved discriminative value of each biomarker alone.

Conclusions

we suggest that low levels of irisin and its inadequate increase during administration of SGLT2i are promising predictors for unfavorable kidney outcome among T2DM patients with concomitant HF. The dynamic changes of the biomarkers  ROC curve analysis
Red cell distribution width - prognostic parameter that could be used in heart failure patients
Authors: Catana A
Published: June 2024

Background

Heart failure (HF) is one of the cardiovascular diseases with high mortality and morbidity and high hospitalization rate, associated with a high degree of disability in terms of quality of life, by reducing exercise capacity and limiting the possibilities to make individual physical effort.

Although diagnostic and treatment methods are increasingly complex, mortality and hospitalization rates are still very high, which equals a large consumption of financial resources.

Purpose

Identifying a potential prognostic parameter could represent in future a salutary solution for prophylactic intervention in the management of patients with decompensated HF.

Through the present study, I aimed to identify a potential predictive factor by means of which the risk of rehospitalization and mortality in the first year after the last discharge can be evaluated right from the admission of a patient with decompensated HF.

The parameter I set out to research is red cell distribution width (RDW), a parameter easy to obtain by collecting blood samples, that is included in any usual blood count, and expressed in percentages (%), and its normal values are between 12-15%.

The data from the current medical literature regarding the prognostic impact of RDW in the population of patients with HF are minimal, being a topic poorly explored.

Methods

The research was carried out in a retrospective manner on a number of 260 patients with HF, the parameter of interest being RDW.

The main objective of my study was to determine if RDW could represent o possible prognostic parameter in HF patients, by exploring if there is a correlation between its increased values and 3 months, 6 months rehospitalization, and 1 year death.

The statistical analysis was based on the logistic regression model by which I conceived a mathematical formula represented by the following model: Score (of event occurrence) = event estimation coefficient + RDW estimation coefficient * RDW value (Yi= β0+β1Xi+εi ).

To convert the value of the score obtained by applying the above-mentioned formula into probabilities, I applied the following equation: p=1/1+e-score.

Results

Based on the logistic regression model, the statistical results revealed that HF patients with high RDW (at least 14%) had a higher probability of being readmitted at 3 months, 6 months, and of dying at 1 year, the model being considered statistically significant at a p-value below 0.05.

Conclusions

Using logistic regression models, the results of my study revealed that certain negative events in patients with HF such as rehospitalization and 1-year death, can be predicted based on the RDW value, therefore we can consider RDW as a future prognostic predictor in patients with HF. 3-month rehospitaliztion based on RDW  6-month rehospitaliztion based on RDW
Effects of inspiratory muscle training on NT-proBNP level, functional exercises capacity and quality of life in patients with cardiac resynchronization therapy: a pilot study
Authors: Erturk N , Yerlikaya M G , Sayin M R
Published: June 2024

Introduction

It is known that cardiac rehabilitation has improvement effects on exercise capacity and healthy quality of life in patients receiving Cardiac Resynchronization Therapy. However, we did not find a study examining the effect of inspiratory muscle strength training (IMT) on NT-ProBNP, exercise capacity, and health-related quality of life in patients with CRT. Therefore, we planned this study as a pilot study.

Objective

To test the effectiveness of inspiratory muscle training (IMT) on NT-ProBNP level, functional exercise capacity, and quality of life in patients with cardiac resynchronization therapy (CRT).

Methods

Ten individuals with CRT (age: 62.5±12.7; man 60%; NYHA:2; LVEF: 43.5±11.3) were included in this study. The patients underwent a 12-week inspiratory muscle training program (30% of their maximal inspiratory pressures, MIP) using a threshold loading device for 30 minutes per day, seven days per week at home. All patients underwent echocardiographycal examination, assessement of NT-proBNP level, assessed of functional exercises capacity by a 6-minute walk test, and evaluation of quality of life by the Nottingham Health Profile (NHP) questionnaire.

Results

After the IMT, there was no significantly improvement in the LVEF levels (p>0,005). There was a significant decrease in the NT-ProBNP level of 777.6 ng/L ( 1801 to 1103 ng/L, p=0.005) and a significant increase in the 6MWT of 64.21meters (408.5 to 472.7, p=0.005), total NHP score of -121.55 points (244.31 to 122.76, p=0.009).

Conclusions

The 12-week IMT program was able to improve the NT-ProBNP level, functional exercise capacity, and quality of life levels in patients with CRT. The results suggest that IMT can be added to CRT patients' CR program. Randomized controlled studies are needed to investigate the effects of IMT.
Pulse pressure amplification as a predictor of cardiovascular risk in shift workers: an analysis based on PARTAGE
Authors: Abraham F , Leao G , Beltrao C , Gusmao W D , Paiva A , Mota M , Moreno C
Published: June 2024

Background/Introduction

Shift workers are known to have a higher risk of cardiovascular diseases, however there is no precise description of the etiology of these problems. One of the hypotheses refers to the increase in blood pressure due to desynchronization of biological rhythms, in view of work activity, at a time when biologically they should be at rest, which deregulates the endogenous mechanisms of pressure control and vascular elasticity. The Predictive Values of Blood Pressure and Arterial Stiffness in Institutionalized Very Aged Population (PARTAGE) study aimed to evaluate the value of blood pressure and pulse pressure amplification as a predictor of cardiovascular risk. According to the study, when pulse pressure amplification was greater than 10% in the elderly population there was an association with a higher risk of mortality and cardiovascular outcomes.

Purpose

To evaluate whether in shift workers exposed to night work there is an early increase in pulse pressure amplification, as a predictor of cardiovascular risk.

Methods

It was a quantitative, prospective and cross-sectional study. The participants visited collection of sociodemographic data, health conditions, lifestyle habits, work schedules using validated questionnaires and measurements of peripheral blood pressure (PBP) and central blood pressure (CBP), using the Arteris AOP® equipment. Pulse pressure amplification (PPA) was obtained using the following formula: PPA= 100 x (PBP – CBP) / CBP, values are expressed as a percentage.

Results

83 participants were included, with a mean age of 44.4 years, of which 76 (91.6%) were female and 7 (8.4%) were male, only 31 (37.3%) practiced physical activity, 81 (97.6%) were not smokers and 40 (48.2%) were not alcoholics. The average blood pressure values were: PBP 112x80mmHg, CBP 105x81mmHg and PPA was an average of 6.81%. In the univariate regression analysis, no associations were observed between PPA and night work (β = 0.35; p = 0.192) considering adjustments for sex and age, factors that directly influence the central parameters. However, analyzing individually, a total of 7 (8.43%) of shift workers had PPA above the value considered risk for cardiovascular outcomes. Conclusion(s): In the studied population there was no association between PPA and night work, but in some individuals the PPA values were already above the recommended level, that is, they had cardiovascular risk, indicating the need for further studies.
Blood pressure effect of semaglutide in patients with hypertension: an individual patient data analysis of randomised controlled trials
Authors: Kennedy C , Hayes P , Cicero A F G , Dobner S , Le Roux C , Mcevoy J W , Zgaga L , Hennessy M
Published: June 2024

Background

Randomised clinical trials of patients with obesity treated with semaglutide (STEP trials) reported clinically significant reductions in blood pressure (BP). The mean baseline BP of trial participants was in the normal range. The effect of semaglutide on patients with hypertension has yet to be elucidated.

Purpose

To determine the blood pressure effect of semaglutide in patients with uncontrolled BP at randomization (baseline BP).

Methods

Individual participant data from three randomised placebo-controlled trials examining the effect of semaglutide 2.4mg on body weight (STEP 1, 3 and 4) over 68 weeks were included (the Cohort). Participants with systolic BP (SBP) >140mmHg at baseline were identified (HTN140 group). The effect of semaglutide on SBP estimated by ANCOVA with baseline SBP as a covariate. Adjustments of antihypertensive treatment (escalated if treatment started or dose increased; de-escalated if treatment stopped or dose decreased) were assessed using logistic regression analysis adjusted for baseline SBP.

Results

3136 participants were included in the pooled analysis. 397 (13%) had a baseline SBP >140mmHg (semaglutide arm, n=257; placebo arm, n=140). The baseline BP and body weight of the HTN140 group were comparable between treatment arms [Table 1]. The effect of semaglutide on SBP was estimated as -4.09mmHg (95% CI -7.12 to -1.06, p<0.05). This effect was comparable to that for the Cohort (-4.95mmHg; 95% CI -5.86 to -4.05, p<0.05). The observed SBP reduction was 17.41mmHg for those in the semaglutide arm and 12.57mmHg in the placebo arm (Figure 1). This large in-trial effect was partly due to the escalation of anti-hypertensive treatment in 11.3% and 14.3% of participants randomized to semaglutide and placebo respectively (OR 0.76; 95% CI 0.39 to 1.49, p=0.42).

Conclusions

The effect of semaglutide on SBP was not greater in patients with uncontrolled SBP at randomization compared to the Cohort of all patients in STEP 1, 3, 4. The adjustment of anti-hypertensive medications contributed to a large observed reduction in SBP for both trial arms. This demonstrates the Hawthorne effect during these trials.  Effect on SBP
Exercise cardiac magnetic resonance imaging in heart failure with preserved ejection fraction
Authors: Zamani S K , Zaha V G , Sarma S , Macnamara J P , Wakeham D J , Hearon C M , Haykowsky M J , Levine B D , Nelson M D
Published: June 2024

Background

Exercise intolerance is the primary manifestation in heart failure with preserved ejection fraction (HFpEF); yet the pathophysiologic mechanism(s) remains incompletely understood. Exercise cardiac magnetic resonance imaging offers a unique opportunity to examine the cardiac response to simulated activities of daily living, with high spatial resolution, independent of body habitus.

Purpose

To compare the cardiac response to exercise in HFpEF and age-matched healthy controls.

Methods

Twenty-seven individuals with HFpEF (10 Males, BMI: 36 ± 7 kg/m2, age: 71 ± 7 years) and 21 age-matched healthy controls (10 Males, BMI: 27 ± 5 kg/m2, age: 68 ± 5 years) participated. Left ventricular (LV) volumes were assessed by the method of disks, using high-resolution short-axis cine imaging. Brachial artery blood pressure was measured using a brachial oscillometric cuff. Imaging was performed at rest and during supine cycle exercise at 30 Watts using an MRI-compatible ergometer. Control participants also completed a second bout of exercise at 40% of their upright maximum to mimic the average relative intensity that 30 Watts represented in the HFpEF group.

Results

The left ventricular response to exercise in HFpEF patients and age matched controls is summarized in Table 1. At the same absolute workload (i.e., 30 Watts), both groups demonstrated a similar rise in stroke volume and ejection fraction, which was primarily driven by an increase in end-diastolic volume. In contrast, when the control group exercised at a similar relative intensity (i.e., 40% maximum), the increase in stroke volume and ejection fraction was driven almost entirely by a reduction in end-systolic volume.

Conclusions

Taken together, these data provide novel insight into the cardiac response to supine exercise in HFpEF. That left ventricular end-systolic volume was reduced in control participants— but not HFpEF patients— when exercising at a similar relative intensity, highlights a potential cardiac limitation in HFpEF that warrants further investigation.
Safety and efficacy of antiplatelet cessation after transcatheter patent foramen ovale closure
Authors: Apostolos A , Papanikolaou A , Drakopoulou M , Trantalis G , Ktenopoulos N , Simopoulou C , Koliastasis L , Katsaros O , Karmpalioti M , Korovesis T , Vlachakis P , Kachrimanidis I , Aggeli C , Tsioufis C , Toutouzas K
Published: June 2024

Background

Recent large-scale randomized controlled clinical trials have substantiated the safety and efficacy of transcatheter patent foramen ovale (PFO) closure for secondary prevention in patients with a history of cryptogenic stroke. Both European and American guidelines advocate for tailoring with a single antiplatelet agent, either aspirin or clopidogrel, following a 3-6 month course of dual antiplatelet therapy (DAPT). However, the precise duration of single antiplatelet treatment remains uncertain, with varying viewpoints endorsing either lifelong administration or cessation after five years post-intervention with aspirin or clopidogrel following transcatheter PFO closure.

Purpose

The aim of our analysis is to explore the safety and efficacy of antiplatelet cessation after transcatheter patent foramen ovale closure.

Methods

Consecutively treated patients undergoing transcatheter PFO closure at a tertiary hospital were included in our analysis. We meticulously scrutinized baseline demographic details, comorbidities, and pharmaceutical characteristics. This analysis specifically includes patients who were not treated with any type of antithrombotic treatment—antiplatelet or anticoagulant—during follow-up.

Results

A total of twenty-two patients discontinued any antiplatelet agent after transcatheter PFO closure. The majority were female (N=12, 54%), with a mean age of 44.4 ± 6.7 years. Hypertension, dyslipidemia, and diabetes mellitus were present in 3 (13%), 5 (22%), and 3 (13%) patients, respectively. Following transcatheter PFO closure, all patients initially received antithrombotic therapy; however, only one patient did not continue with DAPT at discharge but treated with aspirin per se. The mean duration of DAPT was 4.1±2.5 months; nine patients (40%) continued their treatment with aspirin or clopidogrel after DAPT cessation for a mean duration of 7.7±4.8 months, while the remaining 13 (60%) discontinued the antiplatelet therapy. Over a mean follow-up of 1,026 ± 485 days, only one patient was presented with transient diplopia 985 days after the procedure, which resolved automatically. Subsequent magnetic resonance imaging revealed no new findings.

Conclusion

Our analysis suggests that antiplatelet cessation after PFO closure could be considered in patients without known additional cardiovascular risk factors. However, further validation through larger studies is imperative to solidify these findings and guide clinical decision-making.
Women-focused cardiac rehabilitation delivery around the world and program enablers to support broader implementation
Authors: Ghisi G L M , Supervia M , Turk-Adawi K , Beleigoli A , Contractor A , Mampuya W M , Grace S L
Published: June 2024

Background

Cardiovascular disease prevalence in women is high globally, which leads to a great burden of disability, and it is their leading cause of death. Cardiovascular rehabilitation (CR) is an outpatient model of secondary preventive care proven to mitigate this burden; however, significantly fewer women access CR than men, and those that do are less likely to complete the program. Accordingly, women-focused (W-F) models of CR have been developed, to better engage women and optimize their outcomes.

Purpose

The objectives of this study were to investigate: (1) the implementation of W-F CR by programs around the globe, (2) barriers to delivery of W-F CR, as well as (3) what they would want and need in order to apply the recommendations in their CR programs, particularly with regard to patient education and counselling.

Methods

In this cross-sectional study, a survey was administered to CR programs via REDCap from May-July/2023. Potential respondents were identified via the International Council of Cardiovascular Prevention and Rehabilitation’s (ICCPR) network.

Results

223 responses were received from 52/111 (46.8% country response rate) countries in the world with any CR, across all 6 World Health Organization regions. Thirty-three (14.8%) programs from 30 countries reported offering any W-F programming. Programs did commonly offer elements preferred by women and recommended, namely: patient choice of session time (n=151, 70.6%), informal care providers/partners invited to sessions (n=121, 57.1%), having CR staff with expertise in women and heart diseases (n=112, 53.3%), separate changerooms for women (n=38, 52.8%), and discussing CR referral with patients (n=112, 52.1%). Main barriers to delivery of W-F exercise were physical resources (n=33; 14.8%), space (n=30, 13.5%), as well as staff time (n=26, 11.7%) and expertise (n=33, 10.3%). Main barriers to delivery of W-F education were human resources (n=114, 51.1%), educational resources (n=26, 11.7%) and expertise in the content (n=74, 33.2%). Enablers of W-F education delivery were availability of materials, in multiple modalities, as well as educated staff, and financial resources.

Conclusions

Despite the benefits, W-F CR is not commonly offered globally. Considering the barriers and enablers identified, ICCPR is developing resources to expand delivery. Results from this survey will be used to support implementation of the W-F CR Guideline recommendations such as increasing exercise modality options and psychosocial counselling, and development of W-F educational resources. Map.
The effectiveness of antihypoxic and cardioprotective drug in the rehabilitation of patients with COVID-19 associated pneumonia
Authors: Bondarev S , Stulikova I , Nasrulaev M
Published: June 2024

Introduction

The ability to recover from SARS-CoV-2 depends on the patient's rehabilitation potential and the degree of hypoxia. The possibility of improving the effectiveness of rehabilitation in patients on medications with antihypoxic and cardioprotective properties is relevant and requires study.

Purpose

To study the effectiveness of rehabilitation in patients with COVID-19 pneumonia who were taking phosphocreatine sodium salt.

Material

46 patients 63±25 years old, including 26 men and 20 women, who underwent COVID-19 associated pneumonia with 60±10% lung damage and were discharged from the hospitals for infectious diseases 14.6±5 days ago. According to recommendations of the European Respiratory Society for the 2nd stage of SARS-CoV-2 rehabilitation from 2021, all patients also received breathing exercises and physical therapy. 15 patients, out of 46, received a phosphocreatine sodium 2 g per100mL of saline once per day for 10 days. The duration of the entire rehabilitation was 21 days. The following instrumental examinations were performed: 24-hour Holter ECG monitoring, spiroergometry, and spirometry. For functional assessment and monitoring of patients, the following scaled were used: Borg rating of perceived exertion for dyspnea and fatigue, Hospital Anxiety and Depression Scale (HADS), and the EQ-5D Health-Related Quality of Life Questionnaire.

Results

The following differences were obtained between groups 1 and 2: In group 1, the frequency of supraventricular rhythm disorders (premature supraventricular contractions (PSC) more often than 5000 per day and supraventricular tachycardia (SVT) or atrial tachycardia more than 5 complexes with a heart rate of 120-170 per minute) was 51±6%, whereas in group 2, 19± 5% (P<0.05). The frequency of ventricular heart rhythm disturbances (premature ventricular contractions more than 5000 per day) in group 1 was 20±7%, whereas in group 2, 9±3 (P <0.05). The workload increased from 2.2 ± 0.7 up to 4.1 ± 2.0 MET and from 2.2±0.5 to 5.2±1.2 MET in 1 and 2 groups accordingly. Rating of perceived exertion decreased from 9±2.8 to 4 ±1.4 points in 1 group and from 8.1±1.8 to 2±0.8 points in 2 group. The quality of life increased from 11±3.2 to 6±3.4 points and from 12±2.7 to 1.5±1.2 points. p<0.05.

For the rest of the indicators, there was a positive trend. However, there were no significant differences between groups 1 and 2, p>0.05. For groups 1 and 2, it was, respectively, tidal volume increased from 26±7.0 to 49±8.4 ml/kg, and from 25±6.0 to 52±6.5 ml/kg; anxiety decreased from 10±2 to 4±1.8 and from 10±1.0 to 2±2.0 points; depression decreased from 11±3.0 to 5±2.0 and from 11±0.5 to 4±2.0 points.

Conclusion

Drug with antihypoxic and cardioprotective properties can significantly increase the effectiveness of rehabilitation in patients with COVID-19, reduce the incidence of ventricular and supraventricular heart rhythm disorders, and increase the degree of physical recovery.
Effects of cardiac rehabilitation on the renal function in patients aged 75 years and older with moderate to severe renal dysfunction
Authors: Hama T , Amano K , Ushijima A , Ikari Y , Yoshimachi F
Published: June 2024

Background

As a conservative treatment is an option for end-stage renal failure patients aged 75 years and older in some countries around the world, an effective treatment for the renal function in patients of that age with moderate to severe renal dysfunction might be essential. Our previous study reported that cardiac rehabilitation (CR) improved the renal function in chronic kidney disease (CKD) patients using serum cystatin C (Scys). However, it is unknown whether CR has a favorable effect on the renal function in patients aged 75 years and older with moderate to severe renal dysfunction.

Methods

We conducted a retrospective cohort study of patients admitted to our hospital for evaluating and treating cardiovascular disease from April 2014 to June 2022. The subjects were patients who participated in our 3-month CR program with moderate to severe CKD (estimated glomerular filtration rate based on an Scys [eGFRcys]<45 ml/min/1.73m²) at the beginning of the program. The controls were patients referred to the program but that did not participate. For both groups, patients with the Scys measured upon program referral and approximately 3 months after referral were selected. Dialysis patients were excluded. First, we compared whether there was a significant change in eGFRcys in each group, and then examined whether there was an interaction between the changes in the two groups. Second, to determine the association of any changes in the renal function due to the effects of the CR, we fitted a linear regression model using the percent change in the eGFRcys (%ΔeGFRcys) as an outcome.

Results

Out of 182 patients, there were 136 in the subject group and 46 in the control group. In the subject group, the eGFRcys improved (33.3±8.9 to 35.0±10.5 ml/min/1.73m², p=0.007), but it worsened in the control group (63.4±21.5 to 60.4±22.9 ml/min/1.73m², p=0.014) (Figure 1). There was a significant interaction between the two groups regarding the change in the eGFRcys (p<0.001). The %ΔeGFRcys was larger among the patients that participated in CR (6.69% greater improvement in the %ΔeGFRcys/CR participation; 95% CI, 2.73-10.64%). This association remained significant after adjusting for potential confounders (6.75% greater improvement in the %ΔeGFRcys/CR participation; 95% CI, 1.62-11.88%).

Conclusion

CR might improve the renal function in patients aged 75 years and older with moderate to severe renal dysfunction.
Perception and use of relaxation techniques in cardiovascular disease patients two years after cardiac rehabilitation
Authors: Brito Da Silva H
Published: June 2024

Background

Current literature indicates that stress might accelerate the atherosclerotic process and precipitate the occurrence of cardiovascular events. (1-4) In the framework of risk factor management and secondary prevention, stress reduction through the instruction of relaxation techniques is a standard in Swiss cardiac rehabilitation (CR) institutions. (5) While a spectrum of techniques is applied and instructed, research regarding their impact on perceived quality of life and sustainability in cardiovascular disease (CVD) patients is scarce. (6-9).

Purpose

The objective of this research project was to detect the perceived impact of relaxation techniques on the self- reported quality of life and the stress levels of coronary artery disease patients who underwent cardiac rehabilitation. A further goal was to investigate the adherence of these patients to applying relaxation techniques on a regular basis two years after completing cardiac rehabilitation.

In a further step, the aim was to determine factors for an adequate adherence, in order to improve the instruction and use of relaxation techniques as a secondary prevention measure.

Methods

A semi-structured interview consisting of 10 questions was performed with 18 patients two years upon completion of an outpatient CR program at the Universitätsspital Zürich. The interviews were transcribed after the Kuckartz transcription criteria (10), deductively coded and analyzed with the help of artificial intelligence (AI) for qualitative data.

Results

Regarding the Quality of Life, factors as the ability to work, functional fitness, relationships with relatives and concerns regarding the state of health were reported as more impacting on the state of relaxation in all daily life than relaxation techniques themselves. However, the impact of relaxation techniques on acute stress showed a correlation with quality of life during the time of rehabilitation.

Although the majority of the participants perceived the impact of relaxation techniques on immediate Stress as moderate to high, only 47% of the interviewed reported to apply them regularly two years after the conclusion of cardiac rehabilitation and only 20% used the techniques that were instructed in the rehabilitation setting. Reasons given for the decay in adherence after rehabilitation were a low practicability and a lack in accompaniment and group dynamic, as well as the preference for alternative activities, such as spending time in nature or with relatives.

Conclusions

Although relaxation techniques are reported as moderately to highly impacting on immediate stress, their impact on quality of life is outweighed by other factors. Further, the adherence to a regular relaxation practice declines after CR. In order to improve adherence, patients need easy and practicable techniques and sustainable instruction. The option of a remote or in- person post- rehabilitation setting might be helpful in providing an accompaniment and group dynamic.
Validity of a non-linear heart rate variability index for intensity threshold determination in chronic heart failure patients
Authors: Sempere-Ruiz N , Fuertes-Kenneally L , Manresa-Rocamora A , Baladzhaeva S , Hernandez-Perez I , Blasco-Peris C , Sanz-Rocher A , Garcia-Alvarez M , Climent-Paya V , Sarabia J
Published: June 2024

Experiencing an increasing incidence, chronic heart failure (CHF) demands effective prevention and treatment. Aerobic exercise-based cardiac rehabilitation plays a vital role in managing these patients. However, diverse patient responses underscore the need for precision in intensity prescription. Heart rate variability (HRV), specifically the DFA a1 index, emerges as a cost-effective biomarker for exercise intensity distribution (Rogers et al., 2021a). Previous associations between HRV and ventilatory thresholds in CHF patients suggest its potential utility (Rogers et al., 2021b). This study aims to evaluate the agreement between ventilatory thresholds (VT1 and VT2) and HRV thresholds (HRVT1 and HRVT2) in male and female CHF patients during a cardiopulmonary exercise test. Seventeen males and ten females performed a symptom-limited incremental ramp test on a cycle ergometer. Ventilatory thresholds were determined using a mixed method, and HRV thresholds were calculated using DFA a1 values of 0.75 and 0.5 as the first and second thresholds, respectively. Statistical measures, including the Pearson’s r correlation coefficient, determination coefficient, and Bland-Altman plot with limits of agreement (LoAs), were employed to evaluate the agreement between these methods. Initial findings indicate that HRVT1 shows a non-significant, low positive correlation (r = .36) with VT1, with a determination coefficient of .13, and a mean bias of -5 bpm (LoAs from -35 to 25 bpm). Conversely, HRVT2 demonstrates a significant, strong positive correlation with VT2 (r = .78), presenting a determination coefficient of .62 and a mean bias of 6 bpm (LoAs from -16 to 28 bpm). This suggests promising potential validity for HRVT2 in estimating ventilatory thresholds. In conclusion, while HRVT1 requires further investigation in this population and caution is advised in its application, HRVT2 emerges as a compelling candidate, demonstrating good agreement with VT2 and suggesting its potential validity as a valuable tool for exercise intensity determination in CHF patients.
OUES and mortality in heart failure: a comparison of absolute and percent-predicted values across different equations
Authors: Silveira A D , Leopoldino G , Caceres R C , Garbin H I , Barros F C , Costa G D , Menegazzo W R , Saadi M P , Milani J G P O , Milani M
Published: June 2024

Background

The oxygen uptake efficiency slope (OUES) serves as a prognostic measure derived from cardiopulmonary exercise testing (CPET) in heart failure. Various equations are utilized as references to calculate predicted OUES (1,2). Recently, a new equation, specifically derived from a South American population, has been validated (3). Nevertheless, a comprehensive comparative analysis between mortality prediction in heart failure using the percent-predicted approach based on these equations and absolute values remains to be addressed.

Purpose

To investigate and compare mortality prediction in heart failure using the percent-predicted approach and absolute values of the oxygen uptake efficiency slope (OUES), incorporating Hollenberg (1), Buys (2) and Milani (3) equations.

Methods

This is a retrospective cohort study involving heart failure patients assessed at a tertiary university hospital from 2010 to 2022. All patients underwent symptom-limited maximal cardiopulmonary exercise testing (CPET) and regular follow-ups in a specialized outpatient clinic. The primary outcome was all-cause mortality. We performed a ROC curve analysis to compare the accuracy of the equations and absolute values and to determine the best cut-points. Cox proportional hazards regression was used to assess uni- and multivariate effects of different OUES metrics.

Results

A total of 1,219 patients were included, with 57% being male and a mean age of 55 ± 13 years. The median follow-up was 4.9 years (IQR 3.1 years), resulting in 157 deaths (13%). Ischemic heart disease was present in 31%, and the mean ejection fraction (EF) was 37 ± 15%. Based on EF classification, 66% had reduced EF, 10% had mildly reduced EF, and 24% had preserved EF. ROC curve analysis demonstrated similar accuracy for absolute values and all three equations (Figure 1). The overall model quality was 0.64 for Hollenberg and Buys equations, 0.63 for absolute values, and 0.62 for Milani equations. Absolute OUES had an unadjusted hazard ratio (HR) of 0.999, and percent-predicted OUES using Hollenberg had a HR of 0.973, Buys a HR of 0.967, and Milani a HR of 0.976 for death (P < 0.001 for all comparisons). All comparisons remained significant after age and sex adjustment (P < 0.001).

Conclusions

Our results demonstrate that the oxygen uptake efficiency slope (OUES), whether assessed through percent-predicted or absolute values, exhibits comparable accuracy in predicting mortality among heart failure patients. Distinct cut-offs were established for individual equations. The consistent significance of hazard ratios, even after adjustments for age and sex, underscores the robust prognostic value of OUES metrics. These findings highlight the potential of both OUES and percent-predicted OUES as valuable tools for mortality prediction in heart failure. ROC curve analysis.