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1. Living Lab Data of Patient Needs and Expectations for eHealth-Based Cardiac Rehabilitation in Germany and Spain From the TIMELY Study: Cross-Sectional Analysis

Author

Boris Schmitz, Svenja Wirtz, Manuela Sestayo-Fernández, Hendrik Schäfer, Emma R Douma, Marta Alonso Vazquez, Violeta González-Salvado, Mirela Habibovic, Dimitris Gatsios, Willem Johan Kop, Carlos Peña-Gil, and Frank Mooren

Subjects
Computer applications to medicine. Medical informatics, R858-859.7, Public aspects of medicine, RA1-1270
Abstract

BackgroundThe use of eHealth technology in cardiac rehabilitation (CR) is a promising approach to enhance patient outcomes since adherence to healthy lifestyles and risk factor management during phase III CR maintenance is often poorly supported. However, patients’ needs and expectations have not been extensively analyzed to inform the design of such eHealth solutions. ObjectiveThe goal of this study was to provide a detailed patient perspective on the most important functionalities to include in an eHealth solution to assist them in phase III CR maintenance. MethodsA guided survey as part of a Living Lab approach was conducted in Germany (n=49) and Spain (n=30) involving women (16/79, 20%) and men (63/79, 80%) with coronary artery disease (mean age 57 years, SD 9 years) participating in a structured center-based CR program. The survey covered patients’ perceived importance of different CR components in general, current usage of technology/technical devices, and helpfulness of the potential features of eHealth in CR. Questionnaires were used to identify personality traits (psychological flexibility, optimism/pessimism, positive/negative affect), potentially predisposing patients to acceptance of an app/monitoring devices. ResultsAll the patients in this study owned a smartphone, while 30%-40% used smartwatches and fitness trackers. Patients expressed the need for an eHealth platform that is user-friendly, personalized, and easily accessible, and 71% (56/79) of the patients believed that technology could help them to maintain health goals after CR. Among the offered components, support for regular physical exercise, including updated schedules and progress documentation, was rated the highest. In addition, patients rated the availability of information on diagnosis, current medication, test results, and risk scores as (very) useful. Of note, for each item, except smoking cessation, 35%-50% of the patients indicated a high need for support to achieve their long-term health goals, suggesting the need for individualized care. No major differences were detected between Spanish and German patients (all P>.05) and only younger age (P=.03) but not sex, education level, or personality traits (all P>.05) were associated with the acceptance of eHealth components. ConclusionsThe patient perspectives collected in this study indicate high acceptance of personalized user-friendly eHealth platforms with remote monitoring to improve adherence to healthy lifestyles among patients with coronary artery disease during phase III CR maintenance. The identified patient needs comprise support in physical exercise, including regular updates on personalized training recommendations. Availability of diagnoses, laboratory results, and medications, as part of a mobile electronic health record were also rated as very useful. Trial RegistrationClinicalTrials.gov NCT05461729; https://clinicaltrials.gov/study/NCT05461729

Published
2024
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2. Analysis of the implementation of an innovative IT solution to improve waiting times, communication with primary care and efficiency in Rheumatology

Author

José María Pego-Reigosa, Carlos Peña-Gil, David Rodríguez-Lorenzo, Irene Altabás-González, Naír Pérez-Gómez, John Henry Guzmán-Castro, Rodrigo Varela-Gestoso, Reyes Díaz-Lambarri, Alberto González-Carreró-López, Olga Míguez-Senra, Julia Bóveda-Fontán, Ángeles Charle-Crespo, Francisco Javier Caramés-Casal, Ceferino Barbazán-Álvarez, Íñigo Hernández-Rodríguez, Francisco Maceiras-Pan, Marina Rodríguez-López, Rafael Melero-González, and José Benito Rodríguez-Fernández

Subjects
Rheumatic diseases, Implementation, Early diagnosis, Telemedicine, Medical informatics, Needs assessment, Public aspects of medicine, RA1-1270
Abstract

Abstract Objective To describe in detail an innovative program based on telemedicine for semi-automated prioritization of referrals from Primary Care (PC) to Rheumatology, for reproducibility purposes, and to present the results of the implementation study. Methods The context and situation were carefully analyzed, paying attention to all processes in place, referral numbers, waiting times, and number of complementary tests prior to discharge from Rheumatology. The composition of the team, aims, users, scope, and implementation phases were defined. Eight process indicators were established and measured before and 32 months after the program implementation. Results The program, which includes IT circuits, algorithms based on response to specific guideline-based checklists, e-consultation, and appointments based on priority, was fully implemented in our health area after a pilot study in two PC centers. After implementation, 6185 rheumatology referrals showed an e-consultation response delay of 8.95 days, and to first face-to-face visit (after e-consultation) of 12.6 (previous delay before program implementation was 83.1 days). Resolution by e-consultation reached 20% (1195 patients did not need seeing the rheumatologist to have the problem solved), and 1369 patients (32%) were discharged after the first visit. The overall resolution rate was 44.0% (2564 discharges/5830 e-consultations). From a random sample of 100 visits, only 10% of patients needed additional complementary tests to make a diagnosis and decision by Rheumatology (20.9% decrease from previous period). Conclusion A careful analysis of the situation and processes, with implementation of simple IT circuits, allows for the improvement of the efficiency and resolution of problems in Rheumatology.

Published
2022
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3. A randomized trial to evaluate the impact of exercise-based cardiac rehabilitation for the prevention of chemotherapy-induced cardiotoxicity in patients with breast cancer: ONCORE study protocol

Author

Estíbaliz Díaz-Balboa, Violeta González-Salvado, Beatriz Rodríguez-Romero, Amparo Martínez-Monzonís, Milagros Pedreira-Pérez, Patricia Palacios-Ozores, Rafael López-López, Carlos Peña-Gil, and José R. González-Juanatey

Subjects
Breast cancer, Cardiotoxicity, Cardiac rehabilitation, Exercise, Cardio-oncology, Anthracyclines, Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract

Abstract Background Anthracyclines and monoclonal antibodies against human epidermal growth factor receptor-2 (HER2) are frequently used to treat breast cancer but they are associated with risk of developing cardiotoxicity. Implementation of cardioprotective strategies as part of breast cancer treatment are needed. To date, a limited number of studies have examined the effectiveness of cardiac rehabilitation programs or exercise programs in the prevention of cardiotoxicity through an integral assessment of cardiac function. The ONCORE study proposes an exercise-based cardiac rehabilitation program as a non-pharmacological tool for the management of chemotherapy-induced cardiotoxicity. Methods The study protocol describes a prospective, randomized controlled trial aimed to determine whether an intervention through an exercise-based CR program can effectively prevent cardiotoxicity induced by anthracyclines and/or anti-HER2 antibodies in women with breast cancer. Three hundred and forty women with breast cancer at early stages scheduled to receive cardiotoxic chemotherapy will be randomly assigned (1:1) to participation in an exercise-based CR program (intervention group) or to usual care and physical activity recommendation (control group). Primary outcomes include changes in left ventricular ejection fraction and global longitudinal strain as markers of cardiac dysfunction assessed by transthoracic echocardiography. Secondary outcomes comprise levels of cardiovascular biomarkers and cardiopulmonary function through peak oxygen uptake determination, physical performance and psychosocial status. Supervised exercise program-related outcomes including safety, adherence/compliance, expectations and physical exercise in- and out-of-hospital are studied as exploratory outcomes. Transthoracic echocardiography, clinical test and questionnaires will be performed at the beginning and two weeks after completion of chemotherapy. Discussion The growing incidence of breast cancer and the risk of cardiotoxicity derived from cancer treatments demand adjuvant cardioprotective strategies. The proposed study may determine if an exercise-based CR program is effective in minimizing chemotherapy-induced cardiotoxicity in this population of women with early-stage breast cancer. The proposed research question is concrete, with relevant clinical implications, transferable to clinical practice and achievable with low risk. Trial registration ClinicalTrials.gov Identifier: NCT03964142. Registered on 28 May 2019. Retrospectively registered. https://clinicaltrials.gov/ct2/show/NCT03964142

Published
2021
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4. Clinical outcomes after cardiac rehabilitation in elderly patients with and without diabetes mellitus: The EU-CaRE multicenter cohort study

Author

Prisca Eser, Thimo Marcin, Eva Prescott, Leonie F. Prins, Evelien Kolkman, Wendy Bruins, Astrid E. van der Velde, Carlos Peña-Gil, Marie-Christine Iliou, Diego Ardissino, Uwe Zeymer, Esther P. Meindersma, Arnoud. W. J. Van’tHof, Ed P. de Kluiver, Markus Laimer, and Matthias Wilhelm

Subjects
Cardiac rehabilitation, Cardiovascular risk factors, Exercise capacity, Peak VO2, Systolic blood pressure, LDL-C, Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract

Abstract Background The prevalence of patients with concomitant cardiovascular disease and diabetes mellitus (DM) is increasing rapidly. We aimed to compare the effectiveness of current cardiac rehabilitation (CR) programs across seven European countries between elderly cardiac patients with and without DM. Methods 1633 acute and chronic coronary artery disease (CAD) patients and patients after valve intervention with an age 65 or above who participated in comprehensive CR (3 weeks to 3 months, depending on centre) were included. Peak oxygen uptake (VO2 peak), body mass index, resting systolic blood pressure, low-density lipoprotein-cholesterol (LDL-C), and glycated haemoglobin (HbA1c) were assessed before start of CR, at termination of CR (variable time point), and 12 months after start of CR, with no intervention after CR. Baseline values and changes from baseline to 12-month follow-up were compared between patients with and without DM using mixed models, and mortality and hospitalisation rates using logistic regression. Results 430 (26.3%) patients had DM. Patients with DM had more body fat, lower educational level, more comorbidities, cardiovascular risk factors, and more advanced CAD. Both groups increased their VO2 peak over the study period but with a significantly lower improvement from baseline to follow-up in patients with DM. In the DM group, change in HbA1c was associated with weight change but not with change in absolute VO2 peak. 12-month cardiac mortality was higher in patients with DM. Conclusions While immediate improvements in VO2 peak after CR in elderly patients with and without DM were similar, 12-month maintenance of this improvement was inferior in patients with DM, possibly related to disease progression. Glycemic control was less favourable in diabetic patients needing insulin in the short- and long-term. Since glycemic control was only related to weight loss but not to increase in exercise capacity, this highlights the importance of weight loss in obese DM patients during CR. Trial registration NTR5306 at trialregister.nl; trial registered 07/16/2015; https://www.trialregister.nl/trial/5166

Published
2020
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5. Prevalence and outcomes of atrial fibrillation in a European healthcare area gained through the processing of a health information technology system

Author

Moisés Rodríguez-Mañero, Estrella López-Pardo, Alberto Cordero-Fort, Jose Luis Martínez-Sande, Carlos Peña-Gil, José Novo Platas, Javier García-Seara, Pilar Mazón, Alfonso Varela-Román, Jose María García-Acuña, and José Ramón González-Juanatey

Subjects
Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract

Introduction: Today's healthcare policies rely heavily on data that has been gathered from multiple small studies in intrinsically varied populations. We sought to describe the prevalence, comorbidities and outcomes of atrial fibrillation (AF) in the population of a specific region where all healthcare centers have implemented a common information technology (IT) structure. Methods: The total number of inhabitants was obtained from the healthcare area's IT system. Information pertaining to AF was derived from various datasets in the data warehouse of the Galician regional health service. Results: In the healthcare area of Santiago de Compostela (n=383 000), the diagnosis of AF was coded in 7990 (2.08%) individuals in 2013. Mean age was 76.83±10.5 years, mean CHA2DS2-VASc score was 3.5, 4056 (50.8%) were female and 72.6% were receiving oral anticoagulants. Up until December 31, 2015, 1361 patients died from all causes (17%), 478 (6%) of them in-hospital, with 30 deaths secondary to intracranial bleeding (0.4%) and 125 to stroke (1.6%). On multivariate analysis, age, gender, heart failure, diabetes, previous thromboembolic events and dementia were independently associated with all-cause mortality. Similarly, age, gender and previous thromboembolic events were associated with future thromboembolic events. Oral anticoagulation was found to be protective against mortality and thromboembolic events. Conclusions: In this study, we report for the first time the true prevalence of diagnosed AF and its clinical characteristics, treatment and prognosis in a Spanish healthcare area, based on the systematic integration of data available from a universally adopted health IT system within the region. Resumo: Introdução: As políticas dos cuidados de saúde confiam essencialmente em dados provenientes de múltiplos pequenos estudos no âmbito de populações diversificadas. Desejamos descrever a prevalência, as comorbilidades e os resultados da fibrilhação auricular (FA) numa população pertencente a uma área específica onde os centros dos cuidados de saúde implementaram uma estrutura informática comum. Métodos: O número total de habitantes foi obtido através do sistema informático das áreas dos cuidados de saúde. A informação relativa à FA provém de diversos conjuntos de dados proveniente do banco de dados do Serviço Saúde da Galiza. Resultados: Na área dos cuidados de saúde de Santiago de Compostela (n = 348 985), ao longo de 2013, o diagnóstico de FA foi codificado em 7990 (2,08%) indivíduos. A idade média foi 76,83 ± 10,5 anos, valor médio CHA2DS2-VASc = 3,5, sendo 4056 (50,8%) mulheres, 72,6% das quais administradas com anticoagulantes orais. Até 31 de dezembro de 2015, 1361 doentes morreram de mortalidade geral (17%). Destes, 478 (6%) estavam internados, tendo sido registadas 30 mortes secundárias a hemorragia intracraneana (0,4%) e 125 acidentes vasculares cerebrais (1,6%). Numa análise multivariável, a idade, o sexo, a insuficiência cardíaca, a diabetes, os eventos tromboembólicos e a demência foram associados independentemente da mortalidade em geral. Do mesmo modo, a idade, o sexo e o(s) tromboembólico(s) prévio(s) foram associados à ocorrência de futuros eventos tromboembólicos. Considerou-se que a anticoagulação oral teve um efeito protetor na mortalidade e nos eventos tromboembólicos. Conclusões: Neste estudo, apresentamos pela primeira vez a prevalência real da FA diagnosticada, com as características clínicas, tratamento e prognóstico de uma área específica de cuidados de saúde em Espanha, em conformidade com a integração sistemática dos dados disponíveis num processamento informático sanitário adotado na região. Keywords: Big data, CHA2DS2-VASc, Atrial fibrillation, Palavras-chave: Bancos de dados, CHA2DS2-VASC2, Fibrilhação auricular

Published
2019
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6. Mortality benefit of long-term angiotensin-converting enzyme inhibitors or angiotensin receptor blockers after successful percutaneous coronary intervention in non-ST elevation acute myocardial infarction

Author

María Cristina González-Cambeiro, Andrea López-López, Emad Abu-Assi, Sergio Raposeiras-Roubín, Carlos Peña-Gil, José García-Acuña, and Ramón González-Juanatey

Subjects
Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract

Introduction and objectives: Angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) have been shown to reduce mortality after myocardial infarction (MI). Current guidelines recommend their prescription in all patients after MI. Limited data are available on whether ACEIs/ARBs still improve prognosis in the contemporary era of non-ST elevation MI (NSTEMI) management. We aimed to evaluate the mortality benefit of ACEIs/ARBs in NSTEMI patients treated successfully with percutaneous coronary intervention (PCI). Methods: We analyzed 2784 patients with NSTEMI treated successfully with in-hospital PCI. Two groups were formed based on ACEI/ARB prescription at discharge. Two propensity score (PS) analyses were performed to control for differences in covariates: one with adjustment among the entire cohort, and the other with PS matching (n=1626). The outcome variable was all-cause mortality at four-year follow-up. Results: There were 1902 (68.3%) patients prescribed ACEIs/ARBs at discharge. When adjusted by PS, ACEI/ARB use was associated with a hazard ratio (HR) for mortality of 0.75 (0.60-0.94; absolute risk reduction [ARR] 4.0%) in the whole cohort (p=0.01).After one-to-one PS matching (n=813 in each group), the mortality rate was significantly lower in patients prescribed ACEIs/ARBs, with HR of 0.77 (0.63-0.94; ARR 3.8%) (p=0.03). Conclusions: In this observational study of patients with NSTEMI, all of them treated successfully by PCI, the use of ACEIs/ARBs was significantly associated with a lower risk of four-year all-cause mortality. Resumo: Introdução e objetivos: Os inibidores da enzima de conversão da angiotensina (IECA) ou os antagonistas do recetor da angiotensina (ARA) mostraram reduzir a mortalidade após enfarte do miocárdio (EM). As guias internacionais atuais recomendam a sua prescrição a todos os doentes após EM. Existem poucos dados disponíveis relativamente a se os IECA/ARA continuam a melhorar o prognóstico na abordagem atual do EM sem elevação do segmento ST (EMSEST). O nosso objetivo foi avaliar o benefício em termos de mortalidade dos IECA ou ARA em doentes com EMSEST, tratados com intervenção coronária percutânea (ICP) com sucesso. Métodos: Analisámos 2784 doentes com EMSEST tratados, de forma bem-sucedida, com ICP durante o internamento hospitalar. Foram constituídos dois grupos com base na prescrição de IECA/ARA aquando da alta. Foram efetuadas duas análises de propensity score para controlar diferenças nas co variáveis: uma com ajuste entre toda a coorte e outra com propensity score matching (n=1,626). A variável resultado foi a mortalidade por qualquer causa, após quatro anos de seguimento. Resultados: Houve 1902 (68,3%) de doentes com IECA/ARA prescritos aquando da alta. Quando ajustado para o propensity score, o uso de IECA/ARA associou-se a um hazard ratio de 0,75 para mortalidade (0,60-0,94; redução do risco absoluto [RRA] 4,0%) em toda a coorte (p=0,01).Após o one-to-one propensity score matching (n=813 em cada grupo), a taxa de mortalidade foi significativamente menor em doentes sob tratamento com IECA/ARA, com um hazard ratio de 0,77 (0,63-0,94; RRA 3,8%) (p=0,03). Conclusões: Neste estudo observacional de doentes com EAMSEST, todos tratados com ICP com sucesso, o uso de IECA/ARA esteve associado a um risco significativamente menor de mortalidade por todas as causas aos quatro anos. Keywords: Angiotensin-converting enzyme inhibitors, Angiotensin receptor blockers, Mortality, Non-ST elevation myocardial infarction, Palavras-chave: Inibidores da enzima de conversão da angiotensina, Antagonistas do recetor da angiotensina, Mortalidade, Enfarte do miocárdio sem elevação do segmento ST

Published
2016
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7. Discrepancy between stress electrocardiographic changes and nuclear myocardial perfusion defects in the prognostic assessment of patients with chest pain

Author

Sergio Raposeiras-Roubin, Miguel Garrido-Pumar, Virginia Pubul-Nuñez, Carlos Peña-Gil, Sonia Argibay-Vázquez, Rosa María Agra-Bermejo, Emad Abu-Assi, Amparo Martínez-Monzonís, Marino Vega, Alvaro Ruibal-Morell, and Jose Ramón González-Juanatey

Subjects
Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract

Objectives: The aim of the present study was to determine the long-term prognostic value provided by the exercise electrocardiographic (ECG) response to nuclear myocardial perfusion imaging (MPI) in the evaluation of patients with chest pain, focusing on patients with a discrepancy between the two tests. Methods: A total of 1460 consecutive patients (777 female; 62.6±11.4 years) undergoing exercise myocardial single-photon emission computed tomography (SPECT) were included. The endpoint was the occurrence of acute coronary syndrome, heart failure or cardiac death during follow-up. Results: Ischemic ECG changes were observed during stress testing in 271 patients (18.5%) and 362 patients (24.7%) had positive (abnormal) exercise MPI results. There was a discrepancy between ECG and SPECT findings in 471 patients (32.2%). During the follow-up period (14.0-39.6 months), 224 patients (15.3%) presented cardiac events. The hazard ratios (HR) of ECG and MPI results to predict events were 1.506 (95% CI: 1.113-2.039) and 10.481 (95% CI: 7.799-14.080), respectively. In patients with negative MPI, the ECG response did not predict events (HR 1.214 [95% CI: 0.646-2.282]), the same as in patients with positive MPI (HR 1.203 [95% CI: 0.848-1.705]). Only in hypertensive patients with positive SPECT did the ECG show significant prognostic value (HR 1.937 [95% CI: 1.030-3.642]). In multivariate analysis, positive MPI proved an independent long-term prognostic factor (HR 10.536 [95% CI: 7.759-14.308]), but not ECG (HR 1.356 [95% CI: 0.994-1.850]). Conclusion: MPI results (normal vs. abnormal) had strong predictive value and discrepant ECG results had no significant additive prognostic value. Resumo: Objetivos: O objetivo do presente estudo foi determinar o valor prognóstico a longo prazo, fornecido pelo eletrocardiograma (ECG) em resposta ao esforço na cintigrafia de perfusão miocárdica (CPM) na avaliação de doentes com dor torácica, com ênfase para os grupos de doentes com discrepância entre os dois testes. Método: Foram incluídos 1460 doentes consecutivos (777 do sexo feminino; 62,6 ± 11,4 anos), submetidos a exercício na cintigrafia de perfusão miocárdica com SPECT. O endpoint foi a presença de síndrome coronária aguda, insuficiência cardíaca ou morte cardíaca durante o seguimento. Resultados: Duzentos e setenta e um doentes (18,5%) apresentaram alterações eletrocardiográficas de isquemia durante o teste de esforço e 362 doentes (24,7%) tinham resultados positivos (anormais) na CPM. A discrepância entre os resultados do ECG e CPM apareceu em 471 doentes (32,2%). Durante o período de seguimento (14,0-39,6 meses), 224 (15,3%) apresentaram eventos cardíacos. O hazard ratio (HR) para predizer eventos dos resultados do ECG e CPM foi de 1,506 (1,113-2,039) e 10,481 (7,799-14,080), respetivamente. No grupo de doentes com CPM negativo, o ECG não prediz eventos [HR 1,214 (0,646-2,282)],e o mesmo acontece no grupo de doentes com CPM positivo [HR 1,203 (0,848-1,705)]. Apenas em doentes hipertensos com CPM positivo, o ECG mostrou valor prognóstico significativo [HR 1,937 (1,030-3,642)]. Na análise multivariada, a CPM positiva foi um fator independente de prognóstico a longo prazo [HR 10,536 (7,759-14,308)], mas não o ECG [HR 1,356 (0,994-1,850)]. Conclusão: O resultado da CPM (normal versus anormal) teve um forte valor preditivo e o resultado discrepante no ECG não teve um valor prognóstico adicional significativo. Keywords: Electrocardiogram, Myocardial perfusion imaging, Stress test, Prognosis, Palavras-chave: Eletrocardiograma, Imagens de perfusão miocárdica, Prova de esforço, Prognóstico

Published
2013
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8. Hospital and 4‐Year Mortality Predictors in Patients With Acute Pulmonary Edema With and Without Coronary Artery Disease

Author

Jaume Figueras, Jordi Bañeras, Carlos Peña‐Gil, José A. Barrabés, Jose Rodriguez Palomares, and David Garcia Dorado

Subjects
acute pulmonary edema, coronary artery disease, long‐term mortality, Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract

BackgroundLong‐term prognosis of acute pulmonary edema (APE) remains ill defined. Methods and ResultsWe evaluated demographic, echocardiographic, and angiographic data of 806 consecutive patients with APE with (CAD) and without coronary artery disease (non‐CAD) admitted from 2000 to 2010. Differences between hospital and long‐term mortality and its predictors were also assessed. CAD patients (n=638) were older and had higher incidence of diabetes and peripheral vascular disease than non‐CAD (n=168), and lower ejection fraction. Hospital mortality was similar in both groups (26.5% vs 31.5%; P=0.169) but APE recurrence was higher in CAD patients (17.3% vs 6.5%; P

Published
2016
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9. Resultados de un programa de ecocardioscopia realizada por neurólogos en el proceso integrado en red de atención al ictus en unidades de imagen cardiaca

Author

Iria López-Dequidt, Amparo Martínez-Monzonis, Carlos Peña-Gil, Adrián González-Maestro, Violeta González-Salvado, Emilio Rodríguez-Castro, María Santamaría-Cadavid, Susana Arias-Rivas, Manuel Rodríguez-Yáñez, José María Prieto González, and José Ramón González-Juanatey

Subjects
Cardiology and Cardiovascular Medicine
Published
2023

10. Results of a focused cardiac ultrasound program conducted by neurologists within a stroke care network with cardiac imaging units

Author

Iria López-Dequidt, Amparo Martínez-Monzonis, Carlos Peña-Gil, Adrián González-Maestro, Violeta González-Salvado, Emilio Rodríguez-Castro, María Santamaría-Cadavid, Susana Arias-Rivas, Manuel Rodríguez-Yáñez, José María Prieto González, and José Ramón González-Juanatey

Subjects
General Medicine
Abstract

Recently, neurologists have begun to perform focused cardiac ultrasound for the detection of a cardiac source of embolism in stroke patients, requiring them to undergo a prior accredited training process. We designed a prospective study to analyze the incidence of heart disease detected by a focused cardiac ultrasound program within a stroke care network with cardiac imaging units and to identify the outcomes of detected structural heart disease at 1 year of follow-up.We included patients admitted to a university hospital for ischemic stroke or a transient ischemic attack between 2017 and 2021 who were evaluated by focused cardiac ultrasound. We studied the presence of structural heart disease and cardioembolic sources. We analyzed cardiovascular events (CVE) during the first year of follow-up.Focused cardiac ultrasound was performed in 706 patients. Structural heart disease was detected in 52.1% and a cardioembolic source in 31.9%. Adverse CVE occurred in 5.49% of the patients in the first year of follow-up. The presence of de novo structural heart disease was independently associated with a higher probability of adverse CVE (HR, 1.72; 95%CI, 1.01- 2.91; P=.046).Focused cardiac ultrasound within a stroke care network with cardiac imaging units is an accessible technique with high diagnostic yield. Its use allows clinical and therapeutic actions in the prevention of stroke recurrences and other CVEs in this group of patients.

Published
2023

11. Breathing pattern and pulmonary gas exchange in elderly patients with and without left ventricular dysfunction - modification with exercise-based cardiac rehabilitation and prognostic value

Author

Prisca Eser, Thimo Marcin, Eva Prescott, Leonie F. Prins, Evelien Kolkman, Wendy Bruins, Astrid E van der Velde, Carlos Peña Gil, Marie-Christine Iliou, Diego Ardissino, Uwe Zeymer, Esther P Meindersma, Arnoud W.J. Van’t Hof, Ed P. de Kluiver, and Matthias Wilhelm

Abstract

AimsIn elderly patients with and without left ventricular dysfunction (LVD) we compared ventilatory parameters from before to after exercise-based cardiac rehabilitation (exCR) and assessed their prognostic value for major adverse cardiovascular events (MACE).Methods and ResultsPatients aged ≥65 years with acute or chronic coronary syndromes (ACS, CCS) without cardiac surgery who participated in a multicentre study on effectiveness of exCR from seven European countries were included. Cardiopulmonary exercise testing (CPET) was performed before, at termination of exCR and at 12 months follow-up. Ventilation (VE), breathing frequency (BF), tidal volume (VT) and end-expiratory carbon dioxide pressure (PETCO2) were measured at rest, at first ventilatory threshold and peak exercise.In 818 patients, age was 72.5±5.4 years, 21.9% were women, 79.8% had ACS, and 151 (18%) had LVD. NYHA functional class was not different between LVD and noLVD (86% NYHA I in each group). Compared to noLVD, in LVD resting VE was increased 8%, resting BF 6%, peak VE, peak VT, and peak PETCO2reduced by 6%, 8%, and 5%, respectively, and VE/VVCO2slope increased by 11%. From before to after exCR, resting VE decreased and peak PETCO2increased significantly more in LVD compared to noLVD. In LVD, higher resting BF, higher nadir VE/VCO2, and lower peak PETCO2at baseline were associated with MACEConclusionsIn elderly patients with ischemic LVD, exaggerated resting ventilation and impaired pulmonary gas exchange during exercise was related to worse outcomes. ExCR was associated with an improvement of abnormal breathing patterns and gas exchange parameters.

Published
2023

12. Consulta electrónica y modelo evolutivo en la asistencia ambulatoria de procesos cardiovasculares

Author

Fernando Soto-Loureiro, Marisol Bravo-Amaro, Emilio Paredes-Galán, Mireya Castro-Verdes, Carlos Peña-Gil, Andrés Íñiguez-Romo, and Francisco Calvo-Iglesias

Subjects
Cardiology and Cardiovascular Medicine
Abstract

Resumen Introduccion y objetivos Describir la implantacion y resultados de la consulta electronica (e-consulta) en cardiologia, para racionalizar la demanda, la accesibilidad y la continuidad asistencial entre atencion primaria (AP) y atencion hospitalaria cardiologica. Metodos Estudio observacional en un area sanitaria de 560.162 habitantes efectuado en 3 fases: fase 0 (2010), analisis de demanda en consultas convencionales de cardiologia; fase 1 (2011-2012), estudio piloto de la e-consulta e instauracion de la consulta de alta resolucion (T1), y fase 2 (2013-2018), generalizacion de la e-consulta (T0) en los 47 centros de AP como requisito previo a la citacion presencial T1, e inicio de consultas monograficas. La herramienta utilizada fue la historia clinica electronica unificada de AP y atencion hospitalaria cardiologica del Servicio Gallego de Salud. Resultados Se atendieron un total de 151.484 consultas, 54.062 primeras y 97.422 sucesivas. Se dio de alta al 31% del total de las consultas, con una relacion sucesivas/primeras de 1,8. La demora media en primeras consultas paso de 84 dias en la fase 0 a 32,6 dias en la fase 2 (p Conclusiones La implantacion de la e-consulta de cardiologia como puerta de entrada a consultas presenciales de cardiologia ha racionalizado la asistencia ambulatoria con seguridad y eficiencia entre AP y atencion hospitalaria cardiologica.

Published
2022

13. Initial Invasive or Conservative Strategy for Stable Coronary Disease

Author

Maron D. J., Hochman J. S., Reynolds H. R., Bangalore S., O'Brien S. M., Boden W. E., Chaitman B. R., Senior R., Lopez-Sendon J., Alexander K. P., Lopes R. D., Shaw L. J., Berger J. S., Newman J. D., Sidhu M. S., Goodman S. G., Ruzyllo W., Gosselin G., Maggioni A. P., White H. D., Bhargava B., Min J. K., John Mancini G. B., Berman D. S., Picard M. H., Kwong R. Y., Ali Z. A., Mark D. B., Spertus J. A., Krishnan M. N., Elghamaz A., Moorthy N., Hueb W. A., Demkow M., Mavromatis K., Bockeria O., Peteiro J., Miller T. D., Szwed H., Doerr R., Keltai M., Selvanayagam J. B., Gabriel Steg P., Held C., Kohsaka S., Mavromichalis S., Kirby R., Jeffries N. O., Harrell F. E., Rockhold F. W., Broderick S., Bruce Ferguson T., Williams D. O., Harrington R. A., Stone G. W., Rosenberg Y, ISCHEMIA Research Group: Joseph Ricci, A Tello Montoliu, A I Robero Aniorte, Abbey Mulder, Abhay A Laddu, Abhinav Goyal, Abhishek Dubey, Abhishek Goyal, Abigail Knighton, Abraham Oomman, Adam J Jaskowiak, Adam Kolodziej, Adam Witkowski, Adnan Hameed, Adriana Anesini, Afshan Hussain, Agne Juceviciene, Agne Urboniene, Agnes Jakal, Agnieszka Szramowska, Ahmad Khairuddin, Ahmed Abdel-Latif, Ahmed Adel, Ahmed Aljzeeri, Ahmed Kamal, Ahmed Talaat, Aimee Mann, Aira Contreras, Ajit Kumar, V K Kumar, Akemi Furukawa, Akshay Bagai, Akvile Smigelskaite, Alain Furber, Alain Rheault, Alaine Melanie Loehr, Alan Rosen, Albert Varga, Albertina Qelaj, Alberto Barioli, Aldo Russo, Alec Moorman, Alejandro Gisbert, Aleksandra Fratczak, Aleksandras Laucevicius, Alena Kuleshova, Alessandro Sionis, Alexander A Sirker, Alexander M Chernyavskiy, Alexandra Craft, Alexandra Vazquez, Alexandre Ciappina Hueb, Alexandre S Colafranseschi, Alexandre Schaan de Quadros, Alexandre Tognon, Ali Alghamdi, Alice Manica Muller, Aline Nogueira Rabaça, Aline Peixoto Deiro, Alison Hallam, Allegra Stone, Allison Schley, Almudena Castro, Alvaro Rabelo Ales, Amanda Germann, Amanda O'Malley, Amar Uxa, Amarachi Ojajuni, Amarino C Oliveira Jr, Amber B Hull, Ambuj Roy, Amer Zarka, Amir Janmohamed, Ammani Brown, Ammy Malinay, Amparo Martinez Monzonis, Amy J Richards, Amy Iskandrian, Amy Ollinger, Ana D Djordjevic-Dikic, Ana Fernández Martínez, Ana Gomes Almeida, Ana Paula Batista, Ana Rita Francisco, Ana S Mladenovic, Ana Santana, Anam Siddiqui, Anastasia M Kuzmina-Krutetskaya, Andras Vertes, Andre S Sousa, Andre Gabriel, André Schmidt, Andrea M Lundeen, Andrea Bartykowszki, Andrea Lorimer, Andrea Mortara, Andrea Pascual, Andreia Coelho, Andreia Rocha, Andrés García-Rincón, Andrew G Howarth, Andrew J Moriarty, Andrew Docherty, Andrew Starovoytov, Andrew Zurick, Andrzej Łabyk, Andrzej Swiatkowski, Andy Lam, Anelise Kawakami, Angela Hoye, Angela Kim, Angelique Smit, Angelo Nobre, Anil V Shah, Anja 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Grazyna Anna Szulczyk, Gregor Simonis, Gregory Kumkumian, Gretchen Ann Peichel, Grzegorz Gajos, Gudrun Steinmaurer, Guilherme G Rucatti, Guilherme Portugal, Guilhermina Cantinho Lopes, Guillem Pons Lladó, Gunnar Frostfelt, Gurpreet S Wander, Gurpreet Gulati, Gustavo Pucci, Hafidz Abd Hadi, Haibo Zhang, Haitao Wang, Halina Marciniak, Han Chen, Hanan Kerr, Hani Najm, Hanna Douglas, Hannah Phillips, Hao Dai, Haojian Dong, Haqeel Jamil, Harikrishnan Sivadasanpillai, Harry Suryapranata, Hassan Reda, Hayley Pomeroy, Heather Barrentine, Heather Golden, Heather Hurlburt, Heidi Wilson, Helen C Tucker, Helene Abergel, Hemalata Siddaram, Hermine Osseni, Herwig Schuchlenz, Hesong Zeng, Hicham Skali, Hilda Solomon, Hollie Horton, Holly Hetrick, Holly Little, Holly Park, Hongjie Chi, Hossam Mahrous, Howard A Levite, Hristo Pejkov, Huajun Li, Hugo Bloise-Adames, Hugo Marques, Hui Zhong, Hui-Min Zhang, Humayrah Hashim, Hung-I Yeh, Hussien El Fishawy, Ian Webb, Iftikhar Kullo, Igor O Grazhdankin, Ihab 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Bermudez, Eapen Punnoose, Edgar L Tay, Edgar Karanjah, Edoardo Verna, Eduardo Hernandez-Rangel, Edward D Nicol, Edward O McFalls, Edward T Martin, Edyta Kaczmarska, Ekaterina I Lubinskaya, Elena A Demchenko, Elena Refoyo Salicio, Eli Feen, Elihú Durán-Cortés, Elisabeth M Janzen, Elise L Hannemann, Elise van Dongen, Elissa Restelli Piloto, Eliza Kaplan, Elizabeta Srbinovska Kostovska, Elizabeth Capasso-Gulve, Elizabeth Congdon, Elizabeth Ferguson, Elizaveta V Zbyshevskaya, Ellen Magedanz, Ellie Fridell, Ellis W Lader, Elvin Kedhi, Emanuela Racca, Emilie Tachot, Emily DeRosa, Encarnación Alonso-Álvarez, Eric Nicollet, Eric Peterson, Erick Alexánderson Rosas, Erick Donato Morales, Erin Orvis, Ermina Moga, Estelle Montpetit, Estevao Figueiredo, Eugene Passamani, Eugenia Nikolsky, Eunice Yeoh, Evgeniy I Kretov, Ewa Szczerba, Ewelina Wojtala, Expedito Eustáquio Ribeiro Silva, F Marin Ortuño, Fabio R Farias, Fabio Fimiani, Fabrizio Rolfo, Fa-Chang Yu, Fadi Hage, Fadi Matar, Fahim Haider 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Niedzwiecka, J David Knight, Jacek Kusmierek, Jackie M White, Jackie Chow, Jacob Udell, Jacqueline E Tamis-Holland, Jacqueline Fannon, Jacquelyn A Quin, Jacquelyn Do, Jaekyeong Heo, Jakub Maksym, James E Davies, James H O'Keefe Jr, James J Jang, James Cha, James Harrison, James Hirsch, James Stafford, James Tatoulis, Jamie Rankin, Jan Henzel, Jan Orga, Jana Tancredi, Janaina Oliveira, Jane Burton, Jane Eckstein, Jane Marucci, Janet P Knight, Janet Blount, Janet Halliday, Janetta Kourzenkova, Janitha Raj, Jan-Malte Sinning, Jaqueline Pozzibon, Jaroslaw Drozdz, Jaroslaw Karwowski, Jason D Glover, Jason Loh Kwok, Jason T Call, Jason Linefsky, Jassira Gomes, Jati Anumpa, Javier J Garcia, Javier Courtis, Jay Meisner, K Jayakumar, Jayne Scales, Jean E Denaro, Jean Michel Juliard, Jean Ho, Jeanette K Stansborough, Jean-Michel Juliard, Jeanne Russo, Jeannette J M Schoep, Jeet Thambyrajah, Jeff Leimberger, Jeffery A Breall, Jeffrey A Kohn, Jeffrey C Milliken, Jeffrey Anderson, Jeffrey Blume, Jeffrey Kanters, Jeffrey Lorin, Jeffrey Moses, Jelena J Stepanovic, Jelena Celutkiene, Jelena Djokic, Jelena Stojkovic, Jenne M Jose, Jenne Manchery, Jennifer A Mull, Jennifer H Czerniak, Jennifer L Stanford, Jennifer Gillis, Jennifer Horst, Jennifer Isaacs, Jennifer Langdon, Jennifer Thomson, Jennifer Tomfohr, Jennifer White, Jen-Yuan Kuo, Jeremy Rautureau, Jerome Fleg, Jessica Berg, Jessica Rodriguez, Jessica Waldron, Jhina Patro, Jia Li, Jiajia Mao, Jiamin Liu, Jian'an Wang, Jianhua Li, Jianxin Zhang, Jie Qi, Jihyun Lyo, Jill Marcus, Jim Blankenship, Jing Zhang, Jingjing Liu, Jing-Yao Fan, Jiun-Yi Li, Jiwan Pradhan, Jiyan Chen, J M Rivera Caravaca, Jo Evans, Joan Garcia Picart, Joan Hecht, Joanna Jaroch, Joanna Zalewska, Joanne Kelly, Joanne Taaffe, João Reynaldo Abbud, João V Vitola, Joaquín V Peñafiel, Jocelyne Benatar, Jody Bindeman, Joe Sabik, Joel Klitch, Johann Christopher, Johannes Aspberg, John D Friedman, John F Beltrame, John F Heitner, John Joseph Graham, John R Davies, John Doan, John Kotter, John Kurian, John Mukai, John Pownall, Jolanta Sobolewska, Jon Kobashigawa, Jonathan L Goldberg, Jonathan W Bazeley, Jonathan Byrne, Jonathan Himmelfarb, Jonathan Leipsic, Jonean Thorsen, Jorge F Trejo Gutierrez, Jorge Escobedo, Jorik Timmer, José A Ortega-Ramírez, José Antonio Marin-Neto, Jose D Salas, Jose Enrique Castillo, Jose Francisco Saraiva, José J Cuenca-Castillo, Jose L Diez, José Luis Narro Villanueva, José Luiz da Vieira, José M Flores-Palacios, Jose Ramon Gonzalez, Jose Seijas Amigo, Jose Fragata, Josep Maria Padró, Josheph F X McGarvey Jr, Joseph Hannan, Joseph Sacco, Joseph Sweeny, Joseph Wiesel, Josephine D Abraham, Joshua P Loh, Joy Burkhardt, Joyce R White, Joyce Riestenberg-Smith, Judit Sebo, Judith L Meadows, Judith Wright, Judy Mae Foltz, Judy Hung, Judy Otis, Juergen Stumpf, Jui-Peng Tsai, Julia S Dionne, Julia de Aveiro Morata, Julie Bunke, Julie Morrow, Julio César Figal, Jun Fujita, Jun Jiang, Junhua Li, Junqing Yang, Juntima Euathrongchit, Jyotsna Garg, K Manjula Rani, K Preethi, Kaatje Goetschalckx, Kai Eggers, Kamalakar Surineni, Kanae Hirase, T R Kapilamoorthy, Karen Calfas, Karen Gratrix, Karen Hallett, Karen Hultberg, Karen Nugent, Karen Petrosyan, Karen Swan, Karolina Kryczka, Karolina Wojtczak-Soska, Karolina Wojtera, Karsten Lenk, Karthik Ramasamy, Katarzyna Łuczak, Katarzyna Malinowska, Kate Pointon, Kate Robb, Katherine Martin, Kathleen Claes, Kathryn Carruthers, Kathy E Siegel, Katia Drouin, Katie Fowler-Lehman, Kavita Rawat, Kay Rowe, Keiichi Fukuda, Keith A A Fox, Ken Mahaffey, Kendra Unterbrink, Kenneth Giedd, Kerrie Van Loo, Kerry Lee, Kerstin Bonin, Kevin R Bainey, Kevin T Harley, Kevin Anstrom, Kevin Chan, Kevin Croce, Kevin Landolfo, Kevin Marzo, Keyur Patel, Khaled Abdul-Nour, Khaled Alfakih, Khaled Dajani, Khaled Ziada, Khaula Baloch, Khrystyna Kushniriuk, Kian-Keong Poh, Kim F Ireland, Kim Holland, Kimberly Ann Byrne, Kimberly E Halverson, Kimberly Elmore, Kimberly Miller-Cox, Kiran Reddy, Kirsten J Quiles, Kirsty Abercrombie, Klaus Matschke, Konrad Szymczyk, Koo Hui Chan, Kotiboinna Preethi, Kozhaya Sokhon, Krissada Meemuk, Kristian Thygesen, Kristin M Salmi, Kristin Newby, Kristina Wippler, Kristine Arges, Kristine Teoh, Krystal Etherington, Krystyna Łoboz-Grudzień, Krzysztof W Reczuch, Krzysztof Bury, Krzysztof Drzymalski, Krzysztof Kukuła, Kuo-Tzu Sung, Kurt Huber, Ladda Douangvila, Lance Sullenberger, Larissa Miranda Trama, Laszlone Matics, Laura Drew, Laura Flint, Laura Keinaite, Laura Sarti, Laurel Kolakaluri, Lawrence M Phillips, Lawrence Friedman, Lawrence Phillips, Lazar Velicki, Leah Howell, Leandro C Maranan, Leanne Cox, Ledjalem Daba, Lei Zhang, Lekshmi Dharmarajan, Leo Bockeria, Leonardo Pizzol Caetano, Leonardo Bridi, Leonid L Bershtein, Leszek Sokalski, Li Hai Yan, Li Li, Lia Nijmeijer, Lidia Sousa, Lihong Xu, Lihua Zhang, Lili Zhang, Lilia Schiavi, Lilian Mazza Barbosa, Lillian L Khor, Lina Felix-Stern, Linda L Hall, Linda M Hollenweger, Linda Arcand, Linda Davidson-Ray, Linda Schwarz, Lindsey N Sikora, Lingping Chi, Lino Patricio, Liping Zhang, Lisa Chaytor, Lisa Hatch, Lisa McCloy, Lisa Wong, Liselotte Persson, Lixin Jiang, Liz Low, Ljiljana Pupic, Loïc Bière, Lorenzo Monti, Lori Christensen, Lori Pritchard, Loriane Black, Lori-Ann Desimone, Lori-Ann Larmand, Lorraine McGregor, Louise Morby, Louise Thomson, Luc Harvey, Luciana de Pádua Baptista, Lucilla Garcia, Ludivine Eliahou, Ludmila Helmer, Luis F Smidt, Luis Bernanrdes, Luis Guzman, Luiz A Carvalho, Luyang Xiong, Lynette L Teo, Lynn M Neeson, Lynne Winstanley, M Barbara Srichai-Parsia, M Quintana Giner, M Sowjanya Reddy, M Valdés Chávarri, M Grazia Rossi, Maarten Simoons, Maayan Konigstein, Maciej Lesiak, Maciej Olsowka, Mafalda Selas, Magalie Corfias, Magdalena Madero Rovalo, Magdalena Łanocha, Magdalena Miller, Magdalena Misztal-Teodorczyk, Magdalena Rantinella, Magdy Abdelhamid, Magnolia Jimenez, Mahboob Alam, Mahevamma Mylarappa, Mahfouz El Shahawy, Mahmoud Mohamed, Mahmud Al-Bustami, Majo X Joseph, Malgorzata Frach, Małgorzta Celińska-Spodar, Malte Helm, Manas Chacko, Mandy Murphy, Manitha Vinod, Manjula Rani, Manu Dhawan, Manuela Mombelli, Marcel Weber, Marcello Galvani, Marcelo Jamus Rodrigues, Marcia F Dubin, Marcia F Werner Bayer, Marcin Szkopiak, Marco Antonio Monsalve, Marco Bizzaro Santos, Marco Magnoni, Marco Marini, Marco Sicuro, Marco Zenati, Marcos Valério Coimbra Resende, Marek Roik, Margalit Bentzvi, Margaret Gilsenan, Margaret Iraola, Margot C Quinn, Maria A Alfonso, Maria Antonieta Pereira Moraes, María Dolores Martínez-Ruíz, María Fernanda Canales, Maria Inês Caetano, Maria P Corral, Maria Pérez García, Maria Victoria Actis, Maria Aguirre, Maria Andreasson, Maria Aprile, Maria Colton, Maria Eugenia Martin, Maria Lasala, Maria Lorenzo, Maria Posada, Maria Shier, Maria Thottam, Mariana V Furtado, Mariana Yumi Okada, Marianna D A Dracoulakis, Marianne De Andrade, Mariano Rubio, Marie Essermark, Marielle Scherrer-Crosbie, Marija T Petrovic, Marija Zdravkovic, Marilyn Black, Marina Garcia, Mario J Garcia, Mariola Szulik, Marisa Orgera, Mark A de Belder, Mark Harbinson, Mark Hyun, Mark Peterson, Mark Xavier, Marlowe Mosley, Marta Capinha, Marta Marcinkiewicz-Siemion, Marta Swiderek, Martha Meyer, Martina Ceseri, Martina Tricoli, Marvin Kronenberg, Mary Williams, Mary Ann Champagne, Mary Colleen Rogge, Mary R Soltau, Mary Streif, Massimo Villella, Massoud Leesar, Matei Claudia, Mateusz Solecki, Matías Nicolás Mungo, Matthew Wall Jr, Matthew Budoff, Matthew Jezior, Matthew Luckie, Matthias Friedrich, Mauren P Haeffner, Maximilian Tscharre, Max-Paul Winter, Mayana Almeida, Mayil S Krishnam, Mayuri Patel, Meenakshi Mishra, Megan Manocchia, Meghana Kakade, Melanie J Munro, Melissa D Chaplin, Melissa LeFevre, Mervyn Andiapen, Michael A Gibson, Michael B Rubens, Michael C Turner, Michael D Shapiro, Michael W Lee, Michael Berlowitz, Michael Davidson, Michael Mack, Michael McDaniel, Michael Mumma, Michal Wlodarczyk, Michel G Khouri, Michel S Slama, Michele Rawlins, Michelle M Bonner, Michelle M Seib, Michelle Chang, Michelle Crowder, Michelle Dixon, Michelle Mayon, Michelle McEvoy, Michelle Yee, Miguel M Fernandes, Miguel Nobre Menezes, Miguel Souto Bayarri, Miguel Barrero, Mikhail T Torosoff, Milan R Dobric, Milan Dobric, Milica Nikola Dekleva, Milind Avdhoot Gadkari, Millie Gomez, Min Tun Kyaw, Miriam Brooks, Miroslav Stevo Martinovic, Mitchel B Lustre, Mohammad Tariq Vakani, Mohammad El-Hajjar, Mohammed Al-Amoodi, Mohammed Hussain, Mohammed Saleem, Moisés Blanco-Calvo, Moisés Jiménez-Santos, Mona Bhatia, Monica Rosca, Monika Laukyte, Montserrat Gracida Blanca, Montserrat Vila Perales, Mouaz H Al-Mallah, Moysés de Oliveira Filho, Mpiko Ntsekhe, Muhamed Saric, Mulei Chen, Myriam Brousseau, Myrthes Emy Takiuti, Nada Cemerlic-Adjic, Nadia Asif, Nadia Gakou, Nafisa Hussain, Nana O Katamadze, Nancy L Clapp, Nancy Aedy, Nandita Nataraj, Nanette K Wenger, Naomi Uchida, Nasrul Ismail, Natalia S Oliveira, Natalia de Carvalho Maffei, Natalie Spitzer, Natasha C Putnam, Naved Aslam, Neamat Mowafy, Neeraj Pandit, Neeraj Parakh, Nevena Garcevic, Ngaire Meadows, Nhi N Tran, Nicholas Danchin, Nicki Lakeman, Nicola Johnston, Nicolas W Shammas, Nicole Saint Vrestil, Nicole Deming, Nier Zhong, Niket Patel, Nikola N Boskovic, Nikolaos Karogiannis, Nikos Werner, Nina Johnston, Ning Zhang, Ning Zhou, Niree Hindoyan, Nirmal Kumar, Nitika Chadha, Nitish Naik, Nodira Aripova, Noloyiso Mtana, Nona A Eskelson, Noor Syamira Mokhtar, Noppon Taksaudom, Nor Asiah Basri, Nora Marchelletta, Norma Hogg, Nungshi Jungla, Nuno Ferreira, Oksana A Lubyanaya, Olga B Nikolaeva, Olga Cañavate, Olga Sobrino, Olga Walesiak, Olga Walter, Olga Zdończyk, Olivia J Lim, Olivia Anaya, Olivia Mancilla, Olivier Dubourg, Olugbenga Bello, Omar Almousalli, Omar Thompson, Oni Olurinde, Or Harel, Osama Raheem, Oscar Méndiz, Óscar Prada-Delgado, Oz Shapira, P Christian Schulze, Pachara Panpunuan, Pal Maurovich-Horvat, Pallav Garg, Paloma Moraga, Pam Singh, Pamela Julian, Pamela Ouyang, Pamela Sigel, Pamela Woodard, Panpan Zhou, Paola Emanuela Poggio, Paola Smanio, Paolo Calabro, Paramjit Jeetley, Pascal Goube, Patricia K Nguyen, Patricia Alarie, Patricia Arakelian, Patricia Arsenault, Patricia Blaise, Patricia Brito, Patricia Cowper, Patricia Endsley, Patricia Mieses, Patrick B Alexander, Patrick Donnelly, Patrick Wilmot, Patrycja Lebioda, Paul C Gordon, Paul Der Mesropian, Paul Galiwango, Paul Hauptman, Paul Kennedy, Paula Beardsley, Paula García-González, Paulo Cury Rezende, Paulo Ricardo Caramori, Pavel S Kozlov, Pedro Canas Silva, Pedro Gabriel Melo Barros E Silva, Pedro Píccaro de Oliveira, Pedro Carvalho, Pedro Modas, Pedro Rio, Peeyush Jain, Peiyu He, Peter A McCullough, Peter H Stone, Peter M Pollak, Peter Douglass, Peter Henriksen, Peter OKane, Peter Ong, Philip Jones, Philip Rogal, Philippe Généreux, Philippe Menasche, Philippe Rheault, Phoebe Goold, Pierre Gervais, Pierre Michaud, Pilar Calvillo, Ping Chai, Piotr Jakubowski, Piotr Pruszczyk, Piotr Slomka, Piyamitr Sritara, Poay-Huan Loh, Poonam Sonawane, Pouneh Samadi, Pragnesh P Parikh, Prakash Deedwania, Pranav M Patel, Praneeth Polamuri, Pratiksha Sharma, Precilia Vasquez, Preeti Kamath, Prince Thomas, Priyadarshani Arambam, Puja K Mehta, Purvez Grant, Pushpa Naik, Qi Zhong, Qian Zhao, Qiang Zhou, Qianqian Yuan, Qin Yu, Qingxian Li, Qiulan Xie, Qiutang Zeng, R J Vindhya, R James Gerlach, Rachel King, Rada Vučić, Radmila Lyubarova, Radoslaw Pracon, Raewyn Fisher, Rafael Beyar, Rafael Diaz, Rafael Selgas, Raffaele Bugiardini, Raffaele Fanelli, Raisa Kavalakkat, V S Rajalekshmi, Rajat S Barua, Rajeev Menon, Rajesh Gopalan Nair, Rajesh Francis, Rajiv Narang, Rakesh Yadav, Ralph Alan Huston, T Ramakrishnan, Ramesh de Silva, Rami El Mahmoud, Ramiro Carvalho, Ramon de Jesús-Pérez, Ramona Stevens, Ran Leng, Ranjan Kachru, Ranjit Kumar Nath, Raquel Sanchez, Raven R Dwyer, Raven Lee, Ray Wyman, Raymond C Wong, Raymond W Little, Raymundo Ocaranza Sanchez, Rebecca J Wimmer, Rebecca Bariciano, Rebecca Otis, Rebekah R Herrmann, Reem Yunis, Reinette Hampson, Renato Abdala Karam, Renee C Hessian, Renee Kaneshiro, Reshma Ravindran, Reto Andreas Gamma, Reyna Bhandari, Reza Arsanjani, Ricardo L Lopes, Ricardo Mendes Oliveira, Ricardo Costa, Richa Bhatt, Richard F Davies, Richard H J Trimlett, Richard Goldweit, Rik Hermanides, Rine Nakanishi, Rinu R Sidh, Risha Patel, Rita Coram, Rizwan A Siddiqui, Rob S Beanlands, Robert J Hamburger, Robert K Riezebos, Robert M Donnino, Robert Bojar, Robert Chilton, Robert Guyton, Robert Henderson, Robert Kornberg, Robert Leber, Robert Mao, Robert Stenberg, Roberta P Santos, Roberto René Favaloro, Roberto Amati, Rodolfo G S D Lima, Rodrigo J Cerci, Rogerio Tumelero, Rohit Tandon, Roma Tewari, Romalisa Miranda-Peats, Ron Wald, Ronald A Mastouri, Ronald G Morford, Ronald G Schwartz, Ronald P Pedalino, Rongrong Hu, Ronnell A Hansen, Ronny A Cohen, Rory Hachamovitch, Rosa Homem, Rosa Sandonato, Rosane Laimer, Rosann Gans, Roxanne Yost, Roy Mathew, Rubén Baleón-Espinosa, Ruben Ramos, Rubine Gevorgyan, Rui Ferreira, Rui Jing, Ruth Pérez-Fernández, S K Dwivedi, S Ramakrishnan, Saadat Khan, Sabahat Bokhari, Sabu Thomas, Sadath Lubna, Sajeeda Parveen Khan, Sajeev Chakanalil Govindan, Saket Girotra, Saleem Kassam, Sallie Canada, Salvador Cruz-Flores, Samaa Mohamed, Samantha Ly, Sameh El Kaffas, Samia Massalha, Sampoornima Setty, Samuel Nwosu, Sandeep Seth, Sandeep Singh, Sander R Niehe, Sandra M Rivest, Sandra S Zier, Sandra Ahoud, Sandy Carr, Sanjay Ganapathi, Sanjay Shetty, Sanjeev Sharma, Santa Jimenez, Santhosh Satheesh, Santiago A Garcia, Sara Fernandez, Sara Karlsson, Sara Salkind, Sara Temiyasathit, Sarah Medina Rodriguez, Sarah Beaudry, Sarah Hadjih, Sarah Williams, Sarah Zahrani, Sarju Ralhan, Sasa Hinic, Sasko Kedev, Satinder Singh, Satoshi Yasuda, Satvic Cholenahally Manjunath, Sau Lee, Scott M Kaczkowski, Scott Kinlay, Sean W Hayes, Sebastian Sobczak, Senait Asier, Sergey A Sayganov, Seth I Sokol, Shaheen Pandie, Shaiful Azmi Yahaya, Shamir Mehta, Shao-Ping Nie, Sharad Chandra, Sharder Islam, Sharon Tai, Sheetal Rupesh Karwa, Sheri Ussery, Sheromani Bajaj, Sherron C Crook, Shigeyuki Nishimura, Shintaro Nakano, Shirin Heydari, Shiv Kumar Choudhary, Shivali Patel, Shobana Ganesan, Shruti Pandey, Shuyang Zhang, Shweta Hande, Siddharth Gadage, Sik-Yin V Tan, Silvia Zottis Poletti, Silvia Riera, Silvia Valbuena, Simon Walsh, Simona Maspoli, Simone Savaris, Si-Ting Feng, So Yang Cho, Solomon Yakubov, Songlin Zhu, Songtao Wang, Sonia Guerrero, Sonika Gupta, Sonja Salinger Martinovic, Sonya Brons, Sorin Brener, Sothinathan Gurunathan, Souheil Saba, Soundarya Nayak, Sowjanya Reddy, Srinivasa Potluri, Sriram Sudarshan, Srun Kuanprasert, Stacie Van Oosterhout, Stamatios Lerakis, Stanley E Cobos, Stefan C Bertog, Stefan M Simović, Stefan Weikl, Stefano Di Marco, Stefano Provasoli, Stephanie A Tirado, Stephanie C Boer, Stephanie M Lane, Stephanie Ferket, Stephanie Kelly, Stephanie Wasmiller, Stephen H McKellar, Stephen P Hoole, Stephen Fremes, Stephen Preston, Steve Leung, Steven A Fein, Steven J Lindsay, Steven P Sedlis, Steven Giovannone, Steven Michael, Steven Weitz, Stijn van Vugt, Subhash Banerjee, Sudhir Naik, Suellen Hosino, Sukie Desire, Sukit Yamwong, Suku T Thambar, Sulagna Mookherjee, Suman Singh, Sundeep Mishra, Sunil Kumar Verma, Supap Kulthawong, Supatchara Khwakhong, Surendra Naik, Suresh Babu, Surin Woragidpoonpol, Suryaprakash Narayanappa, Susan Derbyshire, Susan Gent, Susan Mathus, Susan Milbrandt, Susan Moore, Susan Regan, Susan Stinson, Susan Webber, Susana Silva, Susanna Stevens, Susanne Gruensfelder, Suthara Aramcharoen, Suvarna Kolhe, Suzana Tavares, Suzanne Arnold, Suzanne Welsh, Svetlana Apostolovic, Swapna Kunhunny, Ta-Chuan Hung, Taissa Zappernick, Tali Sharir, Talita Silva, Tamara Colaiácovo Soares, Tapan Umesh Pillay, Tarun K Mittal, Tatiana Trifonova, Tauane Bello Duarte, Tauqir Huk, Téodora Dutoiu, Terrance Chua, Terry Weyand, Thabitha Charles, Theodoros Kofidis, Theresa McCreary, Thierry Lefevre, Thippeekaa Arumairajah, Thitipong Tepsuwan, Thomas J Mulhearn, Thomas M Meyer, Thomas P Rocco, Thomas R Downes, Thomas Crain, Thomas Haldis, Thomas Mathew, Thomas Redick, Thounaojam Indira Devi, Thuraia Nageh, Tia Cauthren, Tiago Silva, Tiffany Little, Tijana Andric, Tina Harding, Titus Lau, Tiziana Formisano, Tiziano Moccetti, Tomasz Ciurus, Tomasz Mazurek, Tomasz Tarchalski, Toshiyuki Nagai, Tri Tran, Tricia Youn, Trish Tucker, Trudie Milner, Tuhina Bose, Tushar Kotecha, Udo Sechtem, Uma S Valeti, Umberto Cucchini, Umesh Badami, Upendra Kaul, V K Bahl, V S Narain, Valentina Casali, Valeria Godoy, Valerie Robesyn, Vamshi P Priya, Vandana Yadav, Vera McKinney, Veronica De Lenges, Veronica Tinnirello, Vicente Miro, Victor Navarro, Victoria Gumerova, Victoria Hernandez, Vidya Seeratan, Vijay Kumar, Vikentiy Y Kozulin, Viktoria Bulkley, Vilmar Veiga Jr, Vincent Setang, C P Vineeth, Virginai Pubull Nuñez, Virginia Fernández-Figares, Vitor Gomes, Viviana Gabriel, Viviane Dos Santos, Viviane Almeida, Vlad A Iliescu, Vladan Mudrenovic, Vladimir Dzavik, Vojislav L Giga, Walter Enrique Mogrovejo, Wan Xian Chan, Wanda C Marfori, Wanda Parker, Warangkana Mekara, Wassim Nona, Wayne Old, Wayne Pennachi, Weerachai Nawarawong, Wei Chen, Wei Su, Weibing Xing, Wei-Ren Lan, Wenda Crawford, Wendy L Stewart, Wendy Drewes, Wenhua Lin, William B Abernethy, William D Salerno, William F Fearon, William Vergoni, William Weintraub, Winnie C Sia, Wlodzimierz J Musial, Xacobe Flores-Ríos, Xavier Garcia-Moll Marimon, Xi Su, Xiang Ma, Xiangqiong Gu, Xiao Wang, Xiaomei Li, Xiaowei Yao, Xin Fu, Xin Su, Xin Zeng, Xinchun Yang, Xiuhong Li, Xuehua Fang, Xutong Wang, Yaming Geng, Yan Yan, Yanek Pépin-Dubois, Yanfu Wang, Yang Wang, Yanmeng Tian, Yaping Huang, Yechen Han, Yesenia Zambrano, Yi-Hsuan Yang, Ying Tung Sia, Yining Yang, Yitong Ma, Yolayfi Peralta, Yongjian Wu, Yu Kunwu, Yu Zhao, Yudong Peng, Yueh-Hung Lin, Yulan Zhao, Yumei Dong, Yunhai Zhao, Yutthaphan Wannasopha, Yvonne Taul, Zakir Sahul, Zalina Kudzoeva, Zbigniew Kalarus, Zeljko Z Markovic, Zhen Huang, Zheng Ji, Zhenyu Liu, Zhou Yue, Zhulin Zhang, Zhuxi Li, Zile Singh Meharwal, Ziliang Bai, Zixiang Yu, Zohra Huda, Zoltan Davidovits

Subjects
Male, Cardiac Catheterization, Computed Tomography Angiography, medicine.medical_treatment, Myocardial Ischemia, Coronary Disease, Coronary Artery Disease, Kaplan-Meier Estimate, 030204 cardiovascular system & hematology, Coronary Angiography, ISCHEMIA Research Group, law.invention, Angina, Coronary artery disease, 0302 clinical medicine, Randomized controlled trial, law, Cardiovascular Disease, Myocardial Revascularization, 030212 general & internal medicine, Coronary Artery Bypass, 11 Medical and Health Sciences, Cardiac catheterization, General Medicine, Middle Aged, humanities, Cardiovascular Diseases, Cardiology, Female, Human, medicine.medical_specialty, Ischemia, Article, 03 medical and health sciences, Geriatric cardiology, Percutaneous Coronary Intervention, General & Internal Medicine, Internal medicine, medicine, Humans, Angina, Unstable, Aged, business.industry, Coronary Artery Bypa, Percutaneous coronary intervention, Bayes Theorem, medicine.disease, Heart failure, Quality of Life, business
Abstract

BACKGROUND: Among patients with stable coronary disease and moderate or severe ischemia, whether clinical outcomes are better in those who receive an invasive intervention plus medical therapy than in those who receive medical therapy alone is uncertain. METHODS: We randomly assigned 5179 patients with moderate or severe ischemia to an initial invasive strategy (angiography and revascularization when feasible) and medical therapy or to an initial conservative strategy of medical therapy alone and angiography if medical therapy failed. The primary outcome was a composite of death from cardiovascular causes, myocardial infarction, or hospitalization for unstable angina, heart failure, or resuscitated cardiac arrest. A key secondary outcome was death from cardiovascular causes or myocardial infarction. RESULTS: Over a median of 3.2 years, 318 primary outcome events occurred in the invasive-strategy group and 352 occurred in the conservative-strategy group. At 6 months, the cumulative event rate was 5.3% in the invasive-strategy group and 3.4% in the conservative-strategy group (difference, 1.9 percentage points; 95% confidence interval [CI], 0.8 to 3.0); at 5 years, the cumulative event rate was 16.4% and 18.2%, respectively (difference, -1.8 percentage points; 95% CI, -4.7 to 1.0). Results were similar with respect to the key secondary outcome. The incidence of the primary outcome was sensitive to the definition of myocardial infarction; a secondary analysis yielded more procedural myocardial infarctions of uncertain clinical importance. There were 145 deaths in the invasive-strategy group and 144 deaths in the conservative-strategy group (hazard ratio, 1.05; 95% CI, 0.83 to 1.32). CONCLUSIONS: Among patients with stable coronary disease and moderate or severe ischemia, we did not find evidence that an initial invasive strategy, as compared with an initial conservative strategy, reduced the risk of ischemic cardiovascular events or death from any cause over a median of 3.2 years. The trial findings were sensitive to the definition of myocardial infarction that was used. (Funded by the National Heart, Lung, and Blood Institute and others; ISCHEMIA ClinicalTrials.gov number, NCT01471522.).

Published
2020

14. Acute heart failure. The quintessential cardiac emergency

Author

Jaume Figueras-Bellot, Carlos Peña-Gil, and Violeta González-Salvado

Subjects
Heart Failure, medicine.medical_specialty, business.industry, Heart failure, Internal medicine, Acute Disease, Cardiology, Humans, Medicine, General Medicine, Emergency Service, Hospital, business, medicine.disease
Published
2022

16. A randomized trial to evaluate the impact of exercise-based cardiac rehabilitation for the prevention of chemotherapy-induced cardiotoxicity in patients with breast cancer: ONCORE study protocol

Author

Patricia Palacios-Ozores, José Ramón González-Juanatey, Amparo Martínez-Monzonis, Violeta González-Salvado, Carlos Peña-Gil, Beatriz Rodríguez-Romero, Estíbaliz Díaz-Balboa, Rafael López-López, and Milagros Pedreira-Pérez

Subjects
lcsh:Diseases of the circulatory (Cardiovascular) system, Time Factors, Receptor, ErbB-2, medicine.medical_treatment, Cardiac rehabilitation, 030204 cardiovascular system & hematology, law.invention, HER2 overexpression, Study Protocol, Antineoplastic Agents, Immunological, 0302 clinical medicine, Breast cancer, Randomized controlled trial, law, Anthracyclines, Prospective Studies, Randomized Controlled Trials as Topic, education.field_of_study, Rehabilitation, Ejection fraction, Middle Aged, Exercise Therapy, Cardio-oncology, Treatment Outcome, 030220 oncology & carcinogenesis, Female, Cardiology and Cardiovascular Medicine, Adult, medicine.medical_specialty, Adolescent, Heart Diseases, Population, Breast Neoplasms, Physical exercise, Young Adult, 03 medical and health sciences, Internal medicine, medicine, Humans, education, Exercise, Aged, Cardiotoxicity, business.industry, Cancer, medicine.disease, Spain, lcsh:RC666-701, business
Abstract

Background Anthracyclines and monoclonal antibodies against human epidermal growth factor receptor-2 (HER2) are frequently used to treat breast cancer but they are associated with risk of developing cardiotoxicity. Implementation of cardioprotective strategies as part of breast cancer treatment are needed. To date, a limited number of studies have examined the effectiveness of cardiac rehabilitation programs or exercise programs in the prevention of cardiotoxicity through an integral assessment of cardiac function. The ONCORE study proposes an exercise-based cardiac rehabilitation program as a non-pharmacological tool for the management of chemotherapy-induced cardiotoxicity. Methods The study protocol describes a prospective, randomized controlled trial aimed to determine whether an intervention through an exercise-based CR program can effectively prevent cardiotoxicity induced by anthracyclines and/or anti-HER2 antibodies in women with breast cancer. Three hundred and forty women with breast cancer at early stages scheduled to receive cardiotoxic chemotherapy will be randomly assigned (1:1) to participation in an exercise-based CR program (intervention group) or to usual care and physical activity recommendation (control group). Primary outcomes include changes in left ventricular ejection fraction and global longitudinal strain as markers of cardiac dysfunction assessed by transthoracic echocardiography. Secondary outcomes comprise levels of cardiovascular biomarkers and cardiopulmonary function through peak oxygen uptake determination, physical performance and psychosocial status. Supervised exercise program-related outcomes including safety, adherence/compliance, expectations and physical exercise in- and out-of-hospital are studied as exploratory outcomes. Transthoracic echocardiography, clinical test and questionnaires will be performed at the beginning and two weeks after completion of chemotherapy. Discussion The growing incidence of breast cancer and the risk of cardiotoxicity derived from cancer treatments demand adjuvant cardioprotective strategies. The proposed study may determine if an exercise-based CR program is effective in minimizing chemotherapy-induced cardiotoxicity in this population of women with early-stage breast cancer. The proposed research question is concrete, with relevant clinical implications, transferable to clinical practice and achievable with low risk. Trial registration ClinicalTrials.gov Identifier: NCT03964142. Registered on 28 May 2019. Retrospectively registered. https://clinicaltrials.gov/ct2/show/NCT03964142

Published
2021

17. Offering, participation and adherence to cardiac rehabilitation programmes in the elderly: a European comparison based on the EU-CaRE multicentre observational study

Author

Evelien Kolkman, Wendy Bruins, Prisca Eser, Ed P de Kluiver, Óscar Lado-Baleato, Leonie F Prins, Violeta González-Salvado, Marie-Christine Iliou, Uwe Zeymer, José Ramón González Juanatey, Carlos Peña-Gil, Matthias Wilhelm, Diego Ardissino, Carmen Cadarso-Suárez, Guillermo Prada-Ramallal, Arnoud W J van 't Hof, Astrid E van der Velde, Eva Prescott, Cardiologie, MUMC+: MA Med Staf Spec Cardiologie (9), and RS: Carim - H01 Clinical atrial fibrillation

Subjects
medicine.medical_specialty, Acute coronary syndrome, Referral, Epidemiology, Cost effectiveness, medicine.medical_treatment, Coronary Artery Disease, COST-EFFECTIVENESS, Cohort Studies, Quality of life, QUALITY-OF-LIFE, medicine, Humans, Cardiac Surgical Procedures, Aged, Cardiac Rehabilitation, Rehabilitation, business.industry, Secondary prevention, Cardiovascular disease, medicine.disease, Comorbidity, Ageing, Cohort, Physical therapy, Patient Compliance, Observational study, Cardiology and Cardiovascular Medicine, business, Compliance
Abstract

Aims Cardiac rehabilitation (CR) is strongly recommended but participation of elderly patients has not been well characterized. This study aims to analyse current rates and determinants of CR referral, participation, adherence, and compliance in a contemporary European cohort of elderly patients. Methods and results The EU-CaRE observational study included data from consecutive patients aged ≥ 65 with acute coronary syndrome, revascularization, stable coronary artery disease, or heart valve replacement, recruited in eight European centres. Rates and factors determining offering, participation, and adherence to CR programmes and compliance with training sessions were studied across centres, under consideration of extensive-outpatient vs. intensive-inpatient programmes. Three thousand, four hundred, and seventy-one patients were included in the offering and participation analysis. Cardiac rehabilitation was offered to 80.8% of eligible patients, formal contraindications being the main reason for not offering CR. Mean participation was 68.0%, with perceived lack of usefulness and transport issues being principal barriers. Mean adherence to CR programmes of participants in the EU-CaRE study (n = 1663) was 90.3%, with hospitalization/physical impairment as principal causes of dropout. Mean compliance with training sessions was 86.1%. Older age was related to lower offering and participation, and comorbidity was associated with lower offering, participation, adherence, and compliance. Intensive-inpatient programmes displayed higher adherence (97.1% vs. 85.9%, P Conclusion In this European cohort of elderly patients, older age and comorbidity tackled patients’ referral and uptake of CR programmes. Intensive-inpatient CR programmes showed higher completion than extensive-outpatient CR programmes, suggesting this formula could suit some elderly patients.

Published
2021

18. Cardiac rehabilitation of elderly patients in eight rehabilitation units in western Europe: Outcome data from the EU-CaRE multi-centre observational study

Author

Eva Prescott, Prisca Eser, Nicolai Mikkelsen, Annette Holdgaard, Thimo Marcin, Matthias Wilhelm, Carlos Peña Gil, José R González-Juanatey, Feriel Moatemri, Marie Christine Iliou, Steffen Schneider, Eike Schromm, Uwe Zeymer, Esther P Meindersma, Antonio Crocamo, Diego Ardissino, Evelien K Kolkman, Leonie F Prins, Astrid E van der Velde, Arnoud WJ Van’t Hof, Ed P de Kluiver, RS: Carim - H01 Clinical atrial fibrillation, Cardiologie, and MUMC+: MA Med Staf Spec Cardiologie (9)

Subjects
Male, Time Factors, coronary-artery-disease, Epidemiology, Vascular damage Radboud Institute for Health Sciences [Radboudumc 16], men, Cardiac rehabilitation, Coronary Artery Disease, 030204 cardiovascular system & hematology, elderly, survival, EXERCISE CAPACITY, aerobic interval, SUSTAINABILITY, 03 medical and health sciences, 0302 clinical medicine, psychological distress, Risk Factors, follow-up, Humans, 030212 general & internal medicine, HOME, Aged, Exercise Tolerance, cardiorespiratory fitness, heart-failure, Exercise Therapy, Europe, quality of life, Female, Cardiology and Cardiovascular Medicine, exercise training, secondary prevention, Follow-Up Studies
Abstract

Aims The European Cardiac Rehabilitation in the Elderly (EU-CaRE) HORIZON 2020 project compares the sustainable effects of cardiac rehabilitation (CR) in elderly patients. Methods and results A total of 1633 patients with coronary artery disease (CAD) or heart valve replacement (HVR), with or without revascularization, aged 65 or above, who participated in CR were included. Peak oxygen uptake (VO2peak), smoking, body mass index, diet, physical activity, serum lipids, psychological distress and medication were assessed before and after CR (T0 and T1) and after 12 months (T2). Patients undergoing coronary artery bypass surgery or surgical HVR had lower VO2peak at T0 and a greater increase to T1 and T2 (2.8 and 4.4 ml/kg/min, respectively) than CAD patients undergoing percutaneous or no revascularization (1.6 and 1.4 ml/kg/min, respectively). After multivariable adjustment, earlier CR uptake was associated with greater improvements in VO2peak. The proportion of CAD patients with three or more uncontrolled risk factors declined from 58.4% at T0 to 40.1% at T2 ( p Conclusions The outcomes of VO2peak in CR programs across Europe seemed mainly determined by timing of uptake and were maintained or even further improved at 1-year follow-up. Despite significant improvements, 40.1% of CAD patients still had three or more risk factors not at target after 1 year. Differences across sites could not be ascribed to characteristics of the CR programs offered.

Published
2020

19. Consenso de expertos en la asistencia multidisciplinaria y el abordaje integral de la insuficiencia cardiaca. Desde el alta hospitalaria hasta la continuidad asistencial con primaria

Author

Alfonso Valle, Fernando Garza, Luis Almenar, María José Sanz, Raquel Campuzano, Juan Carlos Castillo Domínguez, Rosa Fernández, Eva Pereira, Antonio García Quintana, Marisa Crespo, Javier Mora, Paz Sanz, Javier Segovia, María Inés Gómez, Paola Beltrán, Carlos Peña Gil, Sergio Hevia, Maruan Chabbar, Garazi Oria, Ramón Bover, Vicente Miró, Juan José Gavira, Alejandro Recio, Vicente Arrarte, Carmen de Pablo, José Antonio Alarcón, Xavier Armengol, José Luis Lambert, José Manuel García Pinilla, Maruja Bello, Ángel Montiel, Carolina Ortiz, and Almudena Castro

Subjects
03 medical and health sciences, 0302 clinical medicine, business.industry, Medicine, 030212 general & internal medicine, 030204 cardiovascular system & hematology, Cardiology and Cardiovascular Medicine, business, Humanities
Abstract

Resumen La insuficiencia cardiaca es una enfermedad que precisa un tratamiento multidisciplinario, dadas la diversidad de causas y entornos clinicos implicados que las tratan y las diferentes estrategias terapeuticas que precisan la participacion indispensable de diversas disciplinas. La presencia en los servicios de cardiologia de unidades de insuficiencia cardiaca centradas en el tratamiento de los pacientes con esta afeccion y unidades de rehabilitacion cardiaca que, entre sus indicaciones para la reduccion de la morbimortalidad, tambien estan implicadas en la atencion de esos mismos pacientes puede causar dificultades de coordinacion y perdida de una atencion integral centrada en el paciente. Por estos motivos, en el presente documento se plantea una estrategia de coordinacion entre las diferentes unidades implicadas en el tratamiento de los pacientes dentro de los servicios de cardiologia y la continuidad asistencial con atencion primaria, tanto tras haber conseguido la estabilidad como la interrelacion para una coordinacion posterior mas efectiva.

Published
2020

20. Formación de población adulta lega en soporte vital básico. Una revisión sistemática

Author

Emilio Rodriguez-Ruiz, Alberto Ruano-Ravina, José Ramón González-Juanatey, Antonio Rodríguez-Núñez, Violeta González-Salvado, Cristian Abelairas-Gómez, and Carlos Peña-Gil

Subjects
03 medical and health sciences, 0302 clinical medicine, business.industry, Medicine, 030204 cardiovascular system & hematology, Cardiology and Cardiovascular Medicine, business, Humanities
Abstract

Resumen Introduccion y objetivos La asistencia de los testigos es decisiva para mejorar los resultados de la parada cardiaca extrahospitalaria. Pese al numero creciente de metodos de formacion en soporte vital basico (SVB), la formula mas efectiva no esta definida. Esta revision sistematica pretende describir los posibles metodos de entrenamiento en SVB para poblacion general adulta y analizar su eficacia aspirando a identificar un patron de referencia. Metodos Se reviso la base de datos MEDLINE (de enero de 2006 a julio de 2018) empleando criterios de inclusion y exclusion predefinidos y considerando todos los estudios que evaluaron metodos practicos de formacion en SVB. Dos revisores extrajeron los datos de manera independiente y evaluaron la calidad de los estudios mediante la escala MERSQI (Medical Education Research Study Quality Instrument). Resultados Se incluyeron 27 de los 1.263 estudios identificados. Los ensayos aleatorizados y controlados eran minoria, con una calidad media de 13 sobre 18 y un considerable acuerdo interobservadores. La heterogeneidad de los contenidos y los instrumentos de formacion y evaluacion limitan la comparabilidad. Los metodos guiados por instructor, incluyendo practica y apoyados por dispositivos de retroalimentacion, parecen haber obtenido los mejores resultados y el reentrenamiento facilito la retencion. La formacion mejoro ademas aspectos actitudinales. Conclusiones Aunque los datos no son lo bastante coincidentes para establecer el metodo optimo, hubo una aparente ventaja de los guiados por instructor, con practica y apoyados por retroalimentacion, asi como del reentrenamiento. Futuros estudios deberian perseguir criterios de calidad estandarizados e instrumentos de evaluacion validados para garantizar la coherencia y la comparabilidad.

Published
2020

21. Training adult laypeople in basic life support. A systematic review

Author

Cristian Abelairas-Gómez, Violeta González-Salvado, Carlos Peña-Gil, Emilio Rodriguez-Ruiz, Antonio Rodríguez-Núñez, Alberto Ruano-Ravina, and José Ramón González-Juanatey

Subjects
Adult, medicine.medical_specialty, business.industry, media_common.quotation_subject, education, Gold standard, Pooling, Retraining, Basic life support, General Medicine, 030204 cardiovascular system & hematology, Cardiopulmonary Resuscitation, 03 medical and health sciences, 0302 clinical medicine, Scale (social sciences), Quality Score, Inclusion and exclusion criteria, Humans, Medicine, Quality (business), Medical physics, Educational Measurement, business, Out-of-Hospital Cardiac Arrest, media_common
Abstract

Introduction and objectives Bystander assistance is decisive to enhance the outcomes of out-of-hospital cardiac arrest. Despite an increasing number of basic life support (BLS) training methods, the most effective formula remains undefined. To identify a gold standard, we performed a systematic review describing reported BLS training methods for laypeople and analyzed their effectiveness. Methods We reviewed the MEDLINE database from January 2006 to July 2018 using predefined inclusion and exclusion criteria, considering all studies training adult laypeople in BLS and performing practical skill assessment. Two reviewers independently extracted data and evaluated the quality of the studies using the MERSQI (Medical Education Research Study Quality Instrument) scale. Results Of the 1263 studies identified, 27 were included. Most of them were nonrandomized controlled trials and the mean quality score was 13 out of 18, with substantial agreement between reviewers. The wide heterogeneity of contents, methods and assessment tools precluded pooling of data. Nevertheless, there was an apparent advantage of instructor-led methods, with feedback-supported hands-on practice, and retraining seemed to enhance retention. Training also improved attitudinal aspects. Conclusions While there were insufficiently consistent data to establish a gold standard, instructor-led formulas, hands-on training with feedback devices and frequent retraining seemed to yield better results. Further research on adult BLS training may need to seek standardized quality criteria and validated evaluation instruments to ensure consistency.

Published
2020

22. Predictors for one-year outcomes of cardiorespiratory fitness and cardiovascular risk factor control after cardiac rehabilitation in elderly patients: The EU-CaRE study

Author

Ed P de Kluiver, Arnoud W J Van'tHof, Carlos Peña Gil, Astrid E van der Velde, Wendy Bruins, Marie-Christine Iliou, Evelien Kolkman, Diego Ardissino, Thimo Marcin, Prisca Eser, Uwe Zeymer, Matthias Wilhelm, Eva Prescott, Esther P. Meindersma, Leonie F Prins, RS: Carim - H01 Clinical atrial fibrillation, Cardiologie, and MUMC+: MA Med Staf Spec Cardiologie (9)

Subjects
Male, Survival, Physiology, Cardiovascular Procedures, SURGERY, Vascular damage Radboud Institute for Health Sciences [Radboudumc 16], 030204 cardiovascular system & hematology, Biochemistry, Body Mass Index, 0302 clinical medicine, Endocrinology, Medical Conditions, Medicine and Health Sciences, Diabetes diagnosis and management, Public and Occupational Health, Disease, 030212 general & internal medicine, 2. Zero hunger, education.field_of_study, Multidisciplinary, Coronary Artery Bypass Grafting, Cardiac Rehabilitation, Exercise Tolerance, VO2 max, Middle Aged, 3. Good health, Exercise Therapy, Impact, Physiological Parameters, Cardiorespiratory Fitness, Cardiovascular Diseases, Medicine, Female, Research Article, Acute coronary syndrome, medicine.medical_specialty, HbA1c, Endocrine Disorders, Science, Population, 610 Medicine & health, Surgical and Invasive Medical Procedures, 03 medical and health sciences, All institutes and research themes of the Radboud University Medical Center, Internal medicine, medicine, Diabetes Mellitus, Exercise capacity, Humans, Hemoglobin, Risk factor, education, Aged, business.industry, Prevention, Body Weight, Biology and Life Sciences, Proteins, Cardiorespiratory fitness, Physical Activity, medicine.disease, Diagnostic medicine, Health Care, Blood pressure, Heart Disease Risk Factors, Metabolic Disorders, Observational study, Geriatric Care, business, Body mass index
Abstract

Introduction Studies on effectiveness of cardiac rehabilitation (CR) in elderly cardiovascular disease patients are rare, and it is unknown, which patients benefit most. We aimed to identify predictors for 1-year outcomes of cardiorespiratory fitness and CV risk factor (CVRF) control in patients after completing CR programs offered across seven European countries. Methods Cardiovascular disease patients with minimal age 65 years who participated in comprehensive CR were included in this observational study. Peak oxygen uptake (VO2), body mass index (BMI), resting systolic blood pressure (BPsys), and low-density lipoprotein-cholesterol (LDL-C) were assessed before CR (T0), at termination of CR (T1), and 12 months after start of CR (T2). Predictors for changes were identified by multivariate regression models. Results Data was available from 1241 out of 1633 EU-CaRE patients. The strongest predictor for improvement in peak VO2 was open chest surgery, with a nearly four-fold increase in surgery compared to non-surgery patients. In patients after surgery, age, female sex, physical inactivity and time from index event to T0 were negative predictors for improvement in peak VO2. In patients without surgery, previous acute coronary syndrome and higher exercise capacity at T0 were the only negative predictors. Neither number of attended training sessions nor duration of CR were significantly associated with change in peak VO2. Non-surgery patients were more likely to achieve risk factor targets (BPsys, LDL-C, BMI) than surgery patients. Conclusions In a previously understudied population of elderly CR patients, time between index event and start of CR in surgery and disease severity in non-surgery patients were the most important predictors for long-term improvement of peak VO2. Non-surgery patients had better CVRF control.

Published
2021

23. Improvement in VO2peak predicts readmissions for cardiovascular disease and mortality in patients undergoing cardiac rehabilitation

Author

Hanne Rasmusen, Carmen Cadarso-Suárez, Nicolai Mikkelsen, Jacob Reeh, Carlos Peña Gil, Carla Díaz-Louzao, Eva Prescott, and Óscar Lado-Baleato

Subjects
Secondary prevention, medicine.medical_specialty, Rehabilitation, Epidemiology, business.industry, medicine.medical_treatment, medicine, In patient, Disease, Exercise capacity, Cardiology and Cardiovascular Medicine, Intensive care medicine, business
Abstract

Background Improvement in exercise capacity is a main goal of cardiac rehabilitation but the effects are often lost at long-term follow-up and thus also the benefits on prognosis. We assessed whether improvement in VO2peak during a cardiac rehabilitation programme predicts long-term prognosis. Methods and results We performed a retrospective analysis of 1561 cardiac patients completing cardiac rehabilitation in 2011–2017 in Copenhagen. Mean age was 63.6 (11) years, 74% were male and 84% had coronary artery disease, 6% chronic heart failure and 10% heart valve replacement. The association between baseline VO2peak and improvement after cardiac rehabilitation and being readmitted for cardiovascular disease and/or all-cause mortality was assessed with three different analyses: Cox regression for the combined outcome, for all-cause mortality and a multi-state model. During a median follow-up of 2.3 years, 167 readmissions for cardiovascular disease and 77 deaths occurred. In adjusted Cox regression there was a non-linear decreasing risk of the combined outcome with higher baseline VO2peak and with improvement of VO2peak after cardiac rehabilitation. A similar linear association was seen for all-cause mortality. Applying the multi-state model, baseline VO2peak and change in VO2peak were associated with risk of a cardiovascular disease readmission and with all-cause mortality but not with mortality in those having an intermediate readmission for cardiovascular disease. Conclusion VO2peak as well as change in VO2peak were highly predictive of future risk of readmissions for cardiovascular disease and all-cause mortality. The predictive value did not extend beyond the next admission for a cardiovascular event.

Published
2019

24. Cardiac rehabilitation in the elderly patient in eight rehabilitation units in Western Europe

Author

Ed P de Kluiver, Eike Schromm, Thimo Marcin, Nicolai Mikkelsen, Uwe Zeymer, Matthias Wilhelm, Evelien Kolkman, Leonie F Prins, Diego Ardissino, Arnoud W van 't Hof, Eva Prescott, Annette Holdgaard, Esther P. Meindersma, Feriel Moatemri, Astrid E van der Velde, José Ramón González-Juanatey, Marie Christine Iliou, Prisca Eser, Steffen Schneider, Carlos Peña Gil, Cardiologie, MUMC+: MA Med Staf Spec Cardiologie (9), RS: Carim - H01 Clinical atrial fibrillation, and RS: CARIM - R2.01 - Clinical atrial fibrillation

Subjects
Male, medicine.medical_specialty, Time Factors, Heart Diseases, Epidemiology, medicine.medical_treatment, Vascular damage Radboud Institute for Health Sciences [Radboudumc 16], Medication adherence, heart valve replacement, Comorbidity, 030204 cardiovascular system & hematology, SECONDARY PREVENTION, Risk Assessment, Time-to-Treatment, 03 medical and health sciences, All institutes and research themes of the Radboud University Medical Center, Oxygen Consumption, 0302 clinical medicine, Elderly, Quality of life, Risk Factors, medicine, Humans, Prospective Studies, 030212 general & internal medicine, Heart valve replacement, coronary heart disease, Elderly patient, Geriatric Assessment, Aged, OLDER, Cardiac Rehabilitation, Exercise Tolerance, Rehabilitation, cardiorespiratory fitness, business.industry, Age Factors, MEN, Baseline data, 3. Good health, Europe, Treatment Outcome, Western europe, Physical therapy, Female, Observational study, Cardiology and Cardiovascular Medicine, business
Abstract

Background Due to the progressive deconditioning, comorbidities and higher complication rates, elderly patients are in particular need of cardiac rehabilitation. We compared elderly patients (65+ years old) participating in cardiac rehabilitation, focusing on baseline characteristics, risk factor control and functional assessment. Methods The EU-CaRE study is a prospective study comparing cardiac rehabilitation in eight centres across Western Europe. Consecutive patients with acute coronary syndrome, stable coronary artery disease and heart valve replacement undergoing cardiac rehabilitation were included. Results Of 1633 patients (median age 72 years) participating, 54% had acute coronary syndrome, 33% had stable coronary artery disease and 13% followed valve replacement. Fifty-five per cent had undergone percutaneous coronary intervention and 29% coronary artery bypass grafting. Characteristics varied across centres: 23% (17–27%) were women, 4% (0–12%) were of non-European origin and 16% (4–32%) were living alone. Median time from index event to start of cardiac rehabilitation varied from 11 to 49 days ( p 2peak was relatively low (16 mL/kg per min) and varied significantly between the participating centres, largely unaffected by multivariable adjustment. Overall patients received guideline recommended treatment: 93% (87–97%) were on a statin and 70% (55–85%) an angiotensin-converting enzyme inhibitor/angiotensin receptor blocker. However, risk factor control was inadequate: 58% had three or more risk factors not controlled. Conclusion EU-CaRE provides a snapshot of the elderly population with heart disease participating in cardiac rehabilitation across countries in Western Europe. Risk factors and exercise capacity indicate the continued need for cardiac rehabilitation in these patients. Of concern, the lag-time to start of cardiac rehabilitation needs improvement in many centres.

Published
2019

25. Targeting relatives: Impact of a cardiac rehabilitation programme including basic life support training on their skills and attitudes

Author

Carlos Peña-Gil, Violeta González-Salvado, Carmen Neiro-Rey, Francisco Gude, Cristian Abelairas-Gómez, Antonio Rodríguez-Núñez, and José Ramón González-Juanatey

Subjects
Adult, Male, Health Knowledge, Attitudes, Practice, medicine.medical_specialty, Time Factors, Epidemiology, Defibrillation, medicine.medical_treatment, education, 030204 cardiovascular system & hematology, Risk Assessment, Out of hospital cardiac arrest, Sudden cardiac death, 03 medical and health sciences, 0302 clinical medicine, Risk Factors, Task Performance and Analysis, Myocardial Revascularization, medicine, Humans, Family, Cardiopulmonary resuscitation, Acute Coronary Syndrome, Intensive care medicine, Health Education, Cardiac Rehabilitation, Rehabilitation, business.industry, Basic life support, 030208 emergency & critical care medicine, Middle Aged, medicine.disease, Cardiopulmonary Resuscitation, Exercise Therapy, Death, Sudden, Cardiac, Treatment Outcome, Spain, Female, Ischaemic heart disease, Health education, Cardiology and Cardiovascular Medicine, business
Abstract

Background Training families of patients at risk for sudden cardiac death in basic life support (BLS) has been recommended, but remains challenging. This research aimed to determine the impact of embedding resuscitation training for patients in a cardiac rehabilitation programme on relatives' BLS skill retention at six months. Design Intervention community study. Methods Relatives of patients suffering acute coronary syndrome or revascularization enrolled on an exercise-based cardiac rehabilitation programme were included. BLS skills of relatives linked to patients in a resuscitation-retraining programme (G-CPR) were compared with those of relatives of patients in a standard programme (G-Stan) at baseline, following brief instruction and six months after. Differences in skill performance and deterioration and self-perceived preparation between groups over time were assessed. Results Seventy-nine relatives were included and complete data from 66 (G-Stan=33, G-CPR=33) was analysed. Baseline BLS skills were equally poor, improved irregularly following brief instruction and decayed afterwards. G-CPR displayed six-month better performance and lessened skill deterioration over time compared with G-Stan, including enhanced compliance with the BLS sequence ( p = 0.006 for group*time interaction) and global resuscitation quality ( p = 0.007 for group*time interaction). Self-perceived preparation was higher in G-CPR ( p = 0.002). Conclusions Relatives of patients suffering acute coronary syndrome or revascularization enrolled on a cardiac rehabilitation programme showed poor BLS skills. A resuscitation-retraining cardiac rehabilitation programme resulted in relatives' higher BLS awareness, skill retention and confidence at six months compared with the standard programme. This may suggest a significant impact of this formula on the family setting and support the active role of patients to enhance health education in their environment.

Published
2019

26. A prospective study of the clinical outcomes and prognosis associated with comorbid COPD in the atrial fibrillation population

Author

Estrella López-Pardo, Moisés Rodríguez-Mañero, Javier García-Seara, Alberto Cordero, Pilar Mazón, José Novo-Platas, Jose-Luis Martínez-Sande, María Pereira-Vázquez, José Ramón González-Juanatey, José María García-Acuña, Luis Valdés-Cuadrado, Alberto Ruano-Ravina, Alvaro Martínez-Gomez, and Carlos Peña-Gil

Subjects
COPD, education.field_of_study, medicine.medical_specialty, business.industry, Incidence (epidemiology), Population, Atrial fibrillation, General Medicine, medicine.disease, 03 medical and health sciences, 0302 clinical medicine, 030228 respiratory system, Internal medicine, Cohort, medicine, 030212 general & internal medicine, Adverse effect, business, education, Prospective cohort study, Stroke
Abstract

Background Patients with COPD are at higher risk of presenting with atrial fibrillation (AF). Information about clinical outcomes and optimal medical treatment of AF in the setting of COPD remains missing. We aimed to describe the prevalence of COPD in a sizeable cohort of real-world AF patients belonging to the same healthcare area and to examine the relationship between comorbid COPD and AF prognosis. Methods Prospective analysis performed in a specific healthcare area. Data were obtained from several sources within the "data warehouse of the Galician Healthcare Service" using multiple analytical tools. Statistical analyses were completed using SPSS 19 and STATA 14.0. Results A total of 7,990 (2.08%) patients with AF were registered throughout 2013 in our healthcare area (n=348,985). Mean age was 76.83±10.51 years and 937 (11.7%) presented with COPD. COPD patients had a higher mean CHA2DS2-VASc (4.21 vs 3.46; P=0.02) and received less beta-blocker and more digoxin therapy than those without COPD. During a mean follow-up of 707±103 days, 1,361 patients (17%) died. All-cause mortality was close to two fold higher in the COPD group (28.3% vs 15.5%; P

Published
2019

27. Prevalence and outcomes of atrial fibrillation in a European healthcare area gained through the processing of a health information technology system

Author

Carlos Peña-Gil, José Luis Martínez-Sande, Estrella López-Pardo, Javier García-Seara, José María García-Acuña, Alfonso Varela-Román, Pilar Mazón, José Ramón González-Juanatey, José Novo Platas, Moisés Rodríguez-Mañero, and Alberto Cordero-Fort

Subjects
Male, lcsh:Diseases of the circulatory (Cardiovascular) system, medicine.medical_specialty, Multivariate analysis, Health information technology, Population, Risk Assessment, 03 medical and health sciences, 0302 clinical medicine, Risk Factors, Cause of Death, Atrial Fibrillation, Health care, Prevalence, medicine, Humans, Dementia, 030212 general & internal medicine, education, Stroke, Aged, General Environmental Science, education.field_of_study, business.industry, Anticoagulants, Atrial fibrillation, Prognosis, medicine.disease, Survival Rate, 030228 respiratory system, Spain, lcsh:RC666-701, Heart failure, Emergency medicine, General Earth and Planetary Sciences, Female, Cardiology and Cardiovascular Medicine, business, Medical Informatics
Abstract

Introduction: Today's healthcare policies rely heavily on data that has been gathered from multiple small studies in intrinsically varied populations. We sought to describe the prevalence, comorbidities and outcomes of atrial fibrillation (AF) in the population of a specific region where all healthcare centers have implemented a common information technology (IT) structure. Methods: The total number of inhabitants was obtained from the healthcare area's IT system. Information pertaining to AF was derived from various datasets in the data warehouse of the Galician regional health service. Results: In the healthcare area of Santiago de Compostela (n=383 000), the diagnosis of AF was coded in 7990 (2.08%) individuals in 2013. Mean age was 76.83±10.5 years, mean CHA2DS2-VASc score was 3.5, 4056 (50.8%) were female and 72.6% were receiving oral anticoagulants. Up until December 31, 2015, 1361 patients died from all causes (17%), 478 (6%) of them in-hospital, with 30 deaths secondary to intracranial bleeding (0.4%) and 125 to stroke (1.6%). On multivariate analysis, age, gender, heart failure, diabetes, previous thromboembolic events and dementia were independently associated with all-cause mortality. Similarly, age, gender and previous thromboembolic events were associated with future thromboembolic events. Oral anticoagulation was found to be protective against mortality and thromboembolic events. Conclusions: In this study, we report for the first time the true prevalence of diagnosed AF and its clinical characteristics, treatment and prognosis in a Spanish healthcare area, based on the systematic integration of data available from a universally adopted health IT system within the region. Resumo: Introdução: As políticas dos cuidados de saúde confiam essencialmente em dados provenientes de múltiplos pequenos estudos no âmbito de populações diversificadas. Desejamos descrever a prevalência, as comorbilidades e os resultados da fibrilhação auricular (FA) numa população pertencente a uma área específica onde os centros dos cuidados de saúde implementaram uma estrutura informática comum. Métodos: O número total de habitantes foi obtido através do sistema informático das áreas dos cuidados de saúde. A informação relativa à FA provém de diversos conjuntos de dados proveniente do banco de dados do Serviço Saúde da Galiza. Resultados: Na área dos cuidados de saúde de Santiago de Compostela (n = 348 985), ao longo de 2013, o diagnóstico de FA foi codificado em 7990 (2,08%) indivíduos. A idade média foi 76,83 ± 10,5 anos, valor médio CHA2DS2-VASc = 3,5, sendo 4056 (50,8%) mulheres, 72,6% das quais administradas com anticoagulantes orais. Até 31 de dezembro de 2015, 1361 doentes morreram de mortalidade geral (17%). Destes, 478 (6%) estavam internados, tendo sido registadas 30 mortes secundárias a hemorragia intracraneana (0,4%) e 125 acidentes vasculares cerebrais (1,6%). Numa análise multivariável, a idade, o sexo, a insuficiência cardíaca, a diabetes, os eventos tromboembólicos e a demência foram associados independentemente da mortalidade em geral. Do mesmo modo, a idade, o sexo e o(s) tromboembólico(s) prévio(s) foram associados à ocorrência de futuros eventos tromboembólicos. Considerou-se que a anticoagulação oral teve um efeito protetor na mortalidade e nos eventos tromboembólicos. Conclusões: Neste estudo, apresentamos pela primeira vez a prevalência real da FA diagnosticada, com as características clínicas, tratamento e prognóstico de uma área específica de cuidados de saúde em Espanha, em conformidade com a integração sistemática dos dados disponíveis num processamento informático sanitário adotado na região. Keywords: Big data, CHA2DS2-VASc, Atrial fibrillation, Palavras-chave: Bancos de dados, CHA2DS2-VASC2, Fibrilhação auricular

Published
2019

28. Effectiveness of Home-Based Mobile Guided Cardiac Rehabilitation as Alternative Strategy for Nonparticipation in Clinic-Based Cardiac Rehabilitation among Elderly Patients in Europe:A Randomized Clinical Trial

Author

Wendy Bruins, Ed P de Kluiver, Astrid E van der Velde, Carlos Peña-Gil, Leonie F Prins, Nicolai Mikkelsen, Prisca Eser, Matthias Wilhelm, Feriel Moatemri, Johan A. Snoek, Thijs M. H. Eijsvogels, Esther P. Meindersma, Thimo Marcin, Arnoud W J van 't Hof, E Prescott, Marie-Christine Iliou, José Ramón González-Juanatey, Violeta González-Salvado, RS: Carim - H01 Clinical atrial fibrillation, Cardiologie, and MUMC+: MA Med Staf Spec Cardiologie (9)

Subjects
medicine.medical_specialty, Acute coronary syndrome, medicine.medical_treatment, Vascular damage Radboud Institute for Health Sciences [Radboudumc 16], 030204 cardiovascular system & hematology, law.invention, Coronary artery disease, 03 medical and health sciences, 0302 clinical medicine, PROGRAMS, Randomized controlled trial, law, REPRODUCIBILITY, Internal medicine, medicine, Clinical endpoint, 030212 general & internal medicine, Adverse effect, Rehabilitation, business.industry, Incidence (epidemiology), medicine.disease, predictors, Inclusion and exclusion criteria, Cardiology and Cardiovascular Medicine, business
Abstract

Importance: Although nonparticipation in cardiac rehabilitation is known to increase cardiovascular mortality and hospital readmissions, more than half of patients with coronary artery disease in Europe are not participating in cardiac rehabilitation. Objective: To assess whether a 6-month guided mobile cardiac rehabilitation (MCR) program is an effective therapy for elderly patients who decline participation in cardiac rehabilitation. Design, Setting, and Participants: Patients were enrolled in this parallel multicenter randomized clinical trial from November 11, 2015, to January 3, 2018, and follow-up was completed on January 17, 2019, in a secondary care system with 6 cardiac institutions across 5 European countries. Researchers assessing primary outcome were masked for group assignment. A total of 4236 patients were identified with a recent diagnosis of acute coronary syndrome, coronary revascularization, or surgical or percutaneous treatment for valvular disease, or documented coronary artery disease, of whom 996 declined to start cardiac rehabilitation. Subsequently, 179 patients who met the inclusion and exclusion criteria consented to participate in the European Study on Effectiveness and Sustainability of Current Cardiac Rehabilitation Programmes in the Elderly trial. Data were analyzed from January 21 to October 11, 2019. Interventions: Six months of home-based cardiac rehabilitation with telemonitoring and coaching based on motivational interviewing was used to stimulate patients to reach exercise goals. Control patients did not receive any form of cardiac rehabilitation throughout the study period. Main Outcomes and Measures: The primary outcome parameter was peak oxygen uptake (Vo2peak) after 6 months. Results: Among 179 patients randomized (145 male [81%]; median age, 72 [range, 65-87] years), 159 (89%) were eligible for primary end point analysis. Follow-up at 1 year was completed for 151 patients (84%). Peak oxygen uptake improved in the MCR group (n = 89) at 6 and 12 months (1.6 [95% CI, 0.9-2.4] mL/kg-1/min-1and 1.2 [95% CI, 0.4-2.0] mL/kg-1/min-1, respectively), whereas there was no improvement in the control group (n = 90) (+0.2 [95% CI, -0.4 to 0.8] mL/kg-1/min-1and +0.1 [95% CI, -0.5 to 0.7] mL/kg-1/min-1, respectively). Changes in Vo2peak were greater in the MCR vs control groups at 6 months (+1.2 [95% CI, 0.2 to 2.1] mL/kg-1/min-1) and 12 months (+0.9 [95% CI, 0.05 to 1.8] mL/kg-1/min-1). The incidence of adverse events was low and did not differ between the MCR and control groups. Conclusions and Relevance: These results suggest that a 6-month home-based MCR program for patients 65 years or older with coronary artery disease or a valvular intervention was safe and beneficial in improving Vo2peak when compared with no cardiac rehabilitation. Trial Registration: trialregister.nl Identifier: NL5168.

Published
2021

29. Greater burden of risk factors and less effect of cardiac rehabilitation in elderly with low educational attainment: The Eu-CaRE study

Author

Ingunn E Kjesbu, Arnoud W J van 't Hof, Ed P de Kluiver, Uwe Zeymer, Violeta González-Salvado, Matthias Wilhelm, Astrid E van der Velde, Nicolai Mikkelsen, Diego Ardissino, Eva Prescott, Esther P. Meindersma, Kirstine Lærum Sibilitz, Carlos Peña-Gil, Marie Christine Iliou, RS: Carim - H01 Clinical atrial fibrillation, Cardiologie, and MUMC+: MA Med Staf Spec Cardiologie (9)

Subjects
Gerontology, ACUTE MYOCARDIAL-INFARCTION, Evidence-based practice, PROGNOSIS, Epidemiology, medicine.medical_treatment, Vascular damage Radboud Institute for Health Sciences [Radboudumc 16], Cardiac rehabilitation, 030204 cardiovascular system & hematology, SECONDARY PREVENTION, elderly, socioeconomic status, 03 medical and health sciences, 0302 clinical medicine, Quality of life (healthcare), Oxygen Consumption, Risk Factors, Medicine, Humans, CORONARY-HEART-DISEASE, SOCIOECONOMIC-STATUS, 030212 general & internal medicine, Myocardial infarction, Prospective Studies, Socioeconomic status, Depression (differential diagnoses), Aged, EUROPEAN ASSOCIATION, Rehabilitation, Exercise Tolerance, social inequality, business.industry, cardiovascular prevention, medicine.disease, anxiety, DEPRESSION, Educational attainment, 3. Good health, Quality of Life, Anxiety, Female, medicine.symptom, Cardiology and Cardiovascular Medicine, business, POSITION PAPER
Abstract

Aims Socioeconomic status is a strong predictor of cardiovascular health. The aim of this study was to describe the immediate and long-term effects of cardiac rehabilitation (CR) across socioeconomic strata in elderly cardiac patients in Europe. Methods and results The observational EU-CaRE study is a prospective study with eight CR sites in seven European countries. Patients ≥65 years with coronary heart disease or heart valve surgery participating in CR were consecutively included. Data were obtained at baseline, end of CR and at one-year follow up. Educational level as a marker for socioeconomic status was divided into basic, intermediate and high. The primary endpoint was exercise capacity (peak oxygen consumption (VO2peak)). Secondary endpoints were cardiovascular risk factors, medical treatment and scores for depression, anxiety and quality of life (QoL). A total of 1626 patients were included; 28% had basic, 48% intermediate and 24% high education. A total of 1515 and 1448 patients were available for follow-up analyses at end of CR and one-year, respectively. Patients with basic education were older and more often female. At baseline we found a socioeconomic gradient in VO2peak, lifestyle-related cardiovascular risk factors, anxiety, depression and QoL. The socioeconomic gap in VO2peak increased following CR (p for interaction Conclusions We found a strong socioeconomic gradient in VO2peak and cardiovascular risk factors that was unaffected or worsened after CR. To address inequity in cardiovascular health, the individual adaption of CR according to socioeconomic needs should be considered.

Published
2021

30. Changes and prognostic value of cardiopulmonary exercise testing parameters in elderly patients undergoing cardiac rehabilitation: The EU-CaRE observational study

Author

Wendy Bruins, Carlos Peña Gil, Prisca Eser, Leonie F Prins, Esther P. Meindersma, Evelien Kolkman, Arnoud W J van 't Hof, Eva Prescott, Astrid E van der Velde, Marie-Christine Iliou, Ed P de Kluiver, Uwe Zeymer, Matthias Wilhelm, Diego Ardissino, Thimo Marcin, Cardiologie, MUMC+: MA Med Staf Spec Cardiologie (9), and RS: Carim - H01 Clinical atrial fibrillation

Subjects
Male, Percutaneous, FITNESS, SURGERY, Cardiovascular Procedures, medicine.medical_treatment, Vascular damage Radboud Institute for Health Sciences [Radboudumc 16], Vascular Surgery, 030204 cardiovascular system & hematology, 0302 clinical medicine, Valve replacement, Medicine and Health Sciences, Respiratory function, Public and Occupational Health, 030212 general & internal medicine, Prospective Studies, Coronary Artery Bypass, Respiratory System Procedures, Prospective cohort study, 610 Medicine & health, Heart Valve Prosthesis Implantation, OUTCOMES, Multidisciplinary, Rehabilitation, Cardiac Rehabilitation, Coronary Artery Bypass Grafting, Prognosis, Sports Science, Chemistry, Cardiovascular Diseases, Physical Sciences, Cardiology, Medicine, Female, Research Article, Chemical Elements, medicine.medical_specialty, Science, IMPROVEMENT, Surgical and Invasive Medical Procedures, CAPACITY, 03 medical and health sciences, All institutes and research themes of the Radboud University Medical Center, Oxygen Consumption, Percutaneous Coronary Intervention, Internal medicine, SCORE, Valve Replacement, medicine, Humans, Sports and Exercise Medicine, Exercise, Aged, HEART-FAILURE PATIENTS, business.industry, MORTALITY, Percutaneous coronary intervention, Biology and Life Sciences, Physical Activity, Vascular surgery, Health Care, Oxygen, Logistic Models, ROC Curve, Physical Fitness, Exercise Test, Geriatric Care, business, Mace
Abstract

Objective We aimed 1) to test the applicability of the previously suggested prognostic value of CPET to elderly cardiac rehabilitation patients and 2) to explore the underlying mechanism of the greater improvement in exercise capacity (peak oxygen consumption, VO2) after CR in surgical compared to non-surgical cardiac patients. Methods Elderly patients (≥65 years) commencing CR after coronary artery bypass grafting, surgical valve replacement (surgery-group), percutaneous coronary intervention, percutaneous valve replacement or without revascularisation (non-surgery group) were included in the prospective multi-center EU-CaRE study. CPETs were performed at start of CR, end of CR and 1-year-follow-up. Logistic models and receiver operating characteristics were used to determine prognostic values of CPET parameters for major adverse cardiac events (MACE). Linear models were performed for change in peak VO2 (start to follow-up) and parameters accounting for the difference between surgery and non-surgery patients were sought. Results 1421 out of 1633 EU-CaRE patients performed a valid CPET at start of CR (age 73±5.4, 81% male). No CPET parameter further improved the receiver operation characteristics significantly beyond the model with only clinical parameters. The higher improvement in peak VO2 (25% vs. 7%) in the surgical group disappeared when adjusted for changes in peak tidal volume and haemoglobin. Conclusion CPET did not improve the prediction of MACE in elderly CR patients. The higher improvement of exercise capacity in surgery patients was mainly driven by restoration of haemoglobin levels and improvement in respiratory function after sternotomy. Trial registration Netherlands Trial Register, Trial NL5166.

Published
2021

31. A framework for the automatic description of healthcare processes in natural language: Application in an aortic stenosis integrated care process

Author

Yago Fontenla-Seco, Manuel Lama, Violeta González-Salvado, Carlos Peña-Gil, Alberto Bugarín-Diz, and Universidade de Santiago de Compostela. Centro de Investigación en Tecnoloxías da Información

Subjects
Healthcare processes, Delivery of Health Care, Integrated, Fuzzy linguistic terms, Humans, Process mining, Health Informatics, Aortic Valve Stenosis, Process understanding, Data to text systems, Natural language generation, Language, Natural Language Processing, Computer Science Applications
Abstract

In this paper, we propose a framework for the automatic generation of natural language descriptions of healthcare processes using quantitative and qualitative data and medical expert knowledge. Inspired by the demand of novel ways of conveying process mining analysis results of healthcare processes (Rojas et al., 2016), our framework is based on the most widely used Data-To-Text (D2T) pipeline (Reiter, 2007) and on the usage of process mining techniques. Backed by a general model that handles process data, this framework is able to quantify attributes in time during a process life-span, recall temporal relations and waiting times between events and its possible causes and compare case (patient) attributes between groups, among other features. Through integrating fuzzy quantification techniques, our framework is able to represent relevant quantitative process information with some degree of uncertainty present on it and describe it in natural language involving uncertain terms. A real application over the Aortic Stenosis Integrated Care Process of the University Hospital of Santiago de Compostela is presented, showcasing the potential of our framework for providing natural language descriptions of healthcare processes addressed to medical experts. Following the standards of D2T systems, manual human validation was conducted for the generated natural language descriptions by fifteen medical experts in Cardiology. Validation results are very positive, since a global average of 4.07/5.00 was achieved for questions related to understandability, usefulness and impact of the natural language descriptions on the medical experts work. More precisely, results indicate i) that the modality which conveyed the information most efficiently was natural language ii) a very clear preference of texts over the usual graphic representation of process information as the way for conveying information to experts (4.28/5.00), and iii) natural language descriptions provide relevant and useful information about the process, allowing for its improvement SI

Published
2022

32. Effect of mobile guided cardiac rehabilitation on quality of life – the EU-CaRE randomised clinical trial

Author

E Prescott, Leonie F Prins, Evelien Kolkman, Matthias Wilhelm, T.H.M Eijsvogels, Nicolai Mikkelsen, Houben, Johan A. Snoek, M.C Ilou, A E Van Der Velde, Prisca Eser, Carlos Peña-Gil, Esther P. Meindersma, J.R Gonzales-Juanatey, and A. W. J. van ’t Hof

Subjects
medicine.medical_specialty, Randomization, Rehabilitation, business.industry, medicine.medical_treatment, Percutaneous coronary intervention, Telehealth, Rehabilitation outcome, Clinical trial, Coronary artery bypass surgery, Quality of life (healthcare), Physical therapy, Medicine, Cardiology and Cardiovascular Medicine, business
Abstract

Background and purpose Although participation in cardiac rehabilitation (CR) improves quality of life (QoL), participation in CR, especially among elderly, is limited. We conducted this study to assess whether mobile home-based CR (mCR) increases QoL in elderly (≥65 years old) patients with coronary artery disease (CAD) or a valvular intervention who decline participation in conventional CR. Methods It is designed as a randomised multi-centre study with two parallel arms. Randomisation assigned patients either to mCR or a control group. mCR Consisted of six months of home-based CR with telemonitoring and coaching. Control-group patients did not receive any form of CR throughout the study period. Quality of life was measured with the SF-36v2 questionnaire at 0, 6 and 12 months. Results A total of 179 patients were included in this study (90 control, 89 mCR). A flowchart of the trial is presented in Figure 1. Patients were predominantly male (81.1%). Baseline characteristics can be found in Table 1. Patients using mCR improved on physical QoL after 6 (p=0.026) and 12 (p=0.008) months. There was no difference on mental QoL for both groups (mCR 6 months p=0.563, 12 months p=0.945; control 6 months p=0.589, 12 months p=0.542). No difference existed in QoL between the mCR and control group (physical: 6 months p=0.070, 12 months p=0.150; mental: 6 months p=0.355, 12 months p=0.625). Conclusion Although there is no significant difference in QoL between the control and mCR group, mCR increases physical QoL after 6 and 12 months in elderly patients who decline participation in conventional CR. Therefore E-Health tools should be considered as an alternative for conventional CR when (elderly) patients decline to participate in conventional CR. Figure 1. Flow chart of all eligible patients Funding Acknowledgement Type of funding source: Public grant(s) – EU funding. Main funding source(s): European Union's Horizon 2020 research and innovation programme

Published
2020

33. Delphi consensus recommendations on how to provide cardiovascular rehabilitation in the COVID-19 era

Author

Thomas Berger, Evangelia Kouidi, Ana Abreu, C H Davos, Marie Christine Iliou, Wolfram Doehner, Véronique Cornelissen, Carlo Vigorito, Alain Cohen-Solal, Heinz Völler, Josef Niebauer, Maria Simonenko, Marco Ambrosetti, Elio Venturini, Dominique Hansen, Dan Gaita, Carlos Peña Gil, Hareld M. C. Kemps, Bernhard H. Rauch, Paul Dendale, Nicolle Kraenkel, Chiara Giuseppina Beccaluva, Roberto F E Pedretti, Daniel Neunhaeuserer, Mathias Wilhelm, Marinella Sommaruga, Miguel Mendes, Massimo F Piepoli, Andreas B. Gevaert, Jari A. Laukkanen, Paul Beckers, Ines Frederix, Bruno Pavy, Simona Sarzi Braga, Antonio Mazza, Francesco Maranta, Repositório da Universidade de Lisboa, Ambrosetti, M, Abreu, A, Cornelissen, V, HANSEN, Dominique, Iliou, MC, Kemps, H, Pedretti, RFE, Voller, H, Wilhelm, M, Piepoli, MF, Beccaluva, CG, Beckers, P, Berger, T, Davos, CH, DENDALE, Paul, Doehner, W, FREDERIX, Ines, Gaita, D, Gevaert, A, Kouidi, E, Kraenkel, N, Laukkanen, J, Maranta, F, Mazza, A, Mendes, M, Neunhaeuserer, D, Niebauer, J, Pavy, B, Gil, CP, Rauch, B, Braga, SS, Simonenko, M, Cohen-Solal, A, Sommaruga, M, Venturini, E, Vigorito, C, Future Everyday, and Eindhoven MedTech Innovation Center

Subjects
medicine.medical_specialty, Consensus, Referral, Coronavirus disease 2019 (COVID-19), Delphi Technique, Epidemiology, medicine.medical_treatment, Comorbidity, 030204 cardiovascular system & hematology, SDG 3 – Goede gezondheid en welzijn, Likert scale, 03 medical and health sciences, 0302 clinical medicine, SDG 3 - Good Health and Well-being, COVID-19, Cardiovascular disease, Coronavirus, Prevention, Rehabilitation, Intervention (counseling), medicine, Humans, 030212 general & internal medicine, 610 Medicine & health, Consensus Document, Pandemics, computer.programming_language, COVID-19/epidemiology, Cardiac Rehabilitation, business.industry, SARS-CoV-2, Cardiovascular Diseases/epidemiology, medicine.disease, Cardiovascular Diseases, Family medicine, Human medicine, Cardiology and Cardiovascular Medicine, business, computer, Delphi, Cardiac Rehabilitation/methods, Cardiovascular rehabilitation
Abstract

Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2020. For permissions, please email: journals.permissions@oup.com., This Delphi consensus by 28 experts from the European Association of Preventive Cardiology (EAPC) provides initial recommendations on how cardiovascular rehabilitation (CR) facilities should modulate their activities in view of the ongoing coronavirus disease 2019 (COVID-19) pandemic. A total number of 150 statements were selected and graded by Likert scale [from -5 (strongly disagree) to +5 (strongly agree)], starting from six open-ended questions on (i) referral criteria, (ii) optimal timing and setting, (iii) core components, (iv) structure-based metrics, (v) process-based metrics, and (vi) quality indicators. Consensus was reached on 58 (39%) statements, 48 'for' and 10 'against' respectively, mainly in the field of referral, core components, and structure of CR activities, in a comprehensive way suitable for managing cardiac COVID-19 patients. Panelists oriented consensus towards maintaining usual activities on traditional patient groups referred to CR, without significant downgrading of intervention in case of COVID-19 as a comorbidity. Moreover, it has been suggested to consider COVID-19 patients as a referral group to CR per se when the viral disease is complicated by acute cardiovascular (CV) events; in these patients, the potential development of COVID-related CV sequelae, as well as of pulmonary arterial hypertension, needs to be focused. This framework might be used to orient organization and operational of CR programmes during the COVID-19 crisis.

Published
2020

34. Predictors of pre-rehabilitation exercise capacity in elderly European cardiac patients - The EU-CaRE study

Author

Leonie F Prins, Nicolai Mikkelsen, Thimo Marcin, Marie Christine Iliou, Wendy Bruins, Diego Ardissino, Uwe Zeymer, Matthias Wilhelm, Ed P de Kluiver, Óscar Lado-Baleato, Evelien Kolkman, Carlos Peña Gil, Prisca Eser, Eva Prescott, Astrid E van der Velde, Arnoud W J van 't Hof, Esther P. Meindersma, Carmen Cardaso-Suaréz, RS: Carim - H01 Clinical atrial fibrillation, Cardiologie, and MUMC+: MA Med Staf Spec Cardiologie (9)

Subjects
Male, medicine.medical_specialty, Heart Diseases, Epidemiology, medicine.medical_treatment, Vascular damage Radboud Institute for Health Sciences [Radboudumc 16], cardiovascular-disease, Cardiac rehabilitation, AEROBIC CAPACITY, 610 Medicine & health, 030204 cardiovascular system & hematology, Ventricular Function, Left, 03 medical and health sciences, Coronary artery bypass surgery, 0302 clinical medicine, PEAK OXYGEN-UPTAKE, cardiopulmonary exercise testing, Medicine, Humans, 030212 general & internal medicine, Prospective Studies, older-adults, Aged, DECLINE, Rehabilitation, Ejection fraction, Exercise Tolerance, cardiorespiratory fitness, peak VO2, business.industry, MORTALITY, WOMEN, Cardiorespiratory fitness, Stroke Volume, Exercise capacity, medicine.disease, Comorbidity, Europe, comorbidity, Rehabilitation exercise, Reference values, treadmill, Physical therapy, Exercise Test, Female, Cardiology and Cardiovascular Medicine, business
Abstract

Aims Functional capacity is an important endpoint for therapies oriented to older adults with cardiovascular diseases. The literature on predictors of exercise capacity is sparse in the elderly population. In a longitudinal European study on effectiveness of cardiac rehabilitation of seven European countries in elderly (>65 years) coronary artery disease or valvular heart disease patients, predictors for baseline exercise capacity were determined, and reference ranges for elderly cardiac patients provided. Methods Mixed models were performed in 1282 patients (mean age 72.9 ± 5.4 years, 79% male) for peak oxygen consumption relative to weight (peak VO2; ml/kg per min) with centre as random factor and patient anthropometric, demographic, social, psychological and nutritional parameters, as well as disease aetiology, procedure, comorbidities and cardiovascular risk factors as fixed factors. Results The most important predictors for low peak VO2 were coronary artery bypass grafting or valve surgery, low resting forced expiratory volume, reduced left ventricular ejection fraction, nephropathy and peripheral arterial disease. Each cumulative comorbidity or cardiovascular risk factors reduced exercise capacity by 1.7 ml/kg per min and 1.1 ml/kg per min, respectively. Males had a higher peak VO2 per body mass but not per lean mass. Haemoglobin was significantly linked to peak VO2 in both surgery and non-surgery patients. Conclusions Surgical procedures, cumulative comorbidities and cardiovascular risk factors were the factors with the strongest relation to reduced exercise capacity in the elderly. Expression of peak VO2 per lean mass rather than body mass allows a more appropriate comparison between sexes. Haemoglobin is strongly related to peak VO2 and should be considered in studies assessing exercise capacity, especially in studies on patients after cardiac surgery.

Published
2020

35. Clinical outcomes after cardiac rehabilitation in elderly patients with and without diabetes mellitus: The EU-CaRE multicenter cohort study

Author

Esther P. Meindersma, Ed P de Kluiver, Leonie F Prins, Uwe Zeymer, Matthias Wilhelm, Arnoud. W. J. Van’tHof, Eva Prescott, Thimo Marcin, Astrid E van der Velde, Diego Ardissino, Prisca Eser, Carlos Peña-Gil, Markus Laimer, Wendy Bruins, Marie-Christine Iliou, Evelien Kolkman, RS: Carim - H01 Clinical atrial fibrillation, Cardiologie, and MUMC+: MA Med Staf Spec Cardiologie (9)

Subjects
Male, lcsh:Diseases of the circulatory (Cardiovascular) system, Time Factors, Endocrinology, Diabetes and Metabolism, Health Status, Vascular damage Radboud Institute for Health Sciences [Radboudumc 16], Obesity/mortality, cardiovascular-disease, Cardiac rehabilitation, 030204 cardiovascular system & hematology, Coronary artery disease, 0302 clinical medicine, Weight loss, Risk Factors, GLYCEMIC CONTROL, Cause of Death, Diabetes Mellitus/diagnosis, risk-factors, Cardiovascular risk factors, Original Investigation, Peak VO2, 2. Zero hunger, Exercise Tolerance, PULSE PRESSURE, Age Factors, 3. Good health, Europe, arterial stiffness, Treatment Outcome, Systolic blood pressure, Female, medicine.symptom, Heart Diseases/diagnosis, Cardiology and Cardiovascular Medicine, Cohort study, medicine.medical_specialty, chronotropic incompetence, HbA1c, Heart Diseases, WEIGHT-LOSS, 030209 endocrinology & metabolism, 610 Medicine & health, ALL-CAUSE, Risk Assessment, Europe/epidemiology, 03 medical and health sciences, BMI, All institutes and research themes of the Radboud University Medical Center, Oxygen Consumption, Internal medicine, Diabetes mellitus, Weight Loss, medicine, Diabetes Mellitus, Exercise capacity, training modalities, Humans, Obesity, LDL-C, Glycemic, Aged, business.industry, Weight change, Recovery of Function, medicine.disease, Blood pressure, Cardiac Rehabilitation/adverse effects, lcsh:RC666-701, business, Body mass index
Abstract

Background The prevalence of patients with concomitant cardiovascular disease and diabetes mellitus (DM) is increasing rapidly. We aimed to compare the effectiveness of current cardiac rehabilitation (CR) programs across seven European countries between elderly cardiac patients with and without DM. Methods 1633 acute and chronic coronary artery disease (CAD) patients and patients after valve intervention with an age 65 or above who participated in comprehensive CR (3 weeks to 3 months, depending on centre) were included. Peak oxygen uptake (VO2 peak), body mass index, resting systolic blood pressure, low-density lipoprotein-cholesterol (LDL-C), and glycated haemoglobin (HbA1c) were assessed before start of CR, at termination of CR (variable time point), and 12 months after start of CR, with no intervention after CR. Baseline values and changes from baseline to 12-month follow-up were compared between patients with and without DM using mixed models, and mortality and hospitalisation rates using logistic regression. Results 430 (26.3%) patients had DM. Patients with DM had more body fat, lower educational level, more comorbidities, cardiovascular risk factors, and more advanced CAD. Both groups increased their VO2 peak over the study period but with a significantly lower improvement from baseline to follow-up in patients with DM. In the DM group, change in HbA1c was associated with weight change but not with change in absolute VO2 peak. 12-month cardiac mortality was higher in patients with DM. Conclusions While immediate improvements in VO2 peak after CR in elderly patients with and without DM were similar, 12-month maintenance of this improvement was inferior in patients with DM, possibly related to disease progression. Glycemic control was less favourable in diabetic patients needing insulin in the short- and long-term. Since glycemic control was only related to weight loss but not to increase in exercise capacity, this highlights the importance of weight loss in obese DM patients during CR. Trial registration NTR5306 at trialregister.nl; trial registered 07/16/2015; https://www.trialregister.nl/trial/5166

Published
2020

36. Training intensity and improvements in exercise capacity in elderly patients undergoing European cardiac rehabilitation - the EU-CaRE multicenter cohort study

Author

Leonie F Prins, Prisca Eser, Uwe Zeymer, Ed P de Kluiver, Carlos Peña Gil, Matthias Wilhelm, Astrid E van der Velde, Marie-Christine Iliou, Thimo Marcin, Evelien Kolkman, Diego Ardissino, Wendy Bruins, Arnoud W J van 't Hof, Esther P. Meindersma, Eva Prescott, RS: Carim - H01 Clinical atrial fibrillation, Cardiologie, and MUMC+: MA Med Staf Spec Cardiologie (9)

Subjects
Male, Physiology, Cardiovascular Procedures, medicine.medical_treatment, Vascular damage Radboud Institute for Health Sciences [Radboudumc 16], Cardiovascular Medicine, 030204 cardiovascular system & hematology, Vascular Medicine, Oxygen Consumption/physiology, Cohort Studies, Medical Conditions, 0302 clinical medicine, Heart Rate, Exercise/physiology, Medicine and Health Sciences, Coronary Heart Disease, Public and Occupational Health, CARDIOVASCULAR PREVENTION, 030212 general & internal medicine, Prospective Studies, 610 Medicine & health, Aged, 80 and over, Cardiac Rehabilitation, Exercise Tolerance, Coronary Artery Bypass Grafting, Multidisciplinary, Rehabilitation, Respiration, Exercise Test/methods, ASSOCIATION, Sports Science, Exercise Therapy, Europe, Cardiovascular Diseases, Medicine, CORONARY-ARTERY-DISEASE, Female, Cardiac Rehabilitation/methods, Heart Rate/physiology, Research Article, Cohort study, medicine.medical_specialty, Patients, Science, Cardiology, Surgical and Invasive Medical Procedures, Work rate, Rehabilitation Medicine, 03 medical and health sciences, Oxygen Consumption, All institutes and research themes of the Radboud University Medical Center, Heart rate, Exercise Tolerance/physiology, medicine, Humans, Sports and Exercise Medicine, Exercise, Aged, Pulmonary Gas Exchange, business.industry, Biology and Life Sciences, Physical Activity, Confidence interval, Exercise Therapy/methods, Health Care, Physical Fitness, Training intensity, Exercise Test, Exercise intensity, Physical therapy, Geriatric Care, Pulmonary Gas Exchange/physiology, Physiological Processes, Ventilatory threshold, business
Abstract

ObjectivesGuidelines for exercise intensity prescription in Cardiac Rehabilitation (CR) are inconsistent and have recently been discussed controversially. We aimed (1) to compare training intensities between European CR centres and (2) to assess associations between training intensity and improvement in peak oxygen consumption (V˙O2) in elderly CR patients.MethodsPeakV˙O2, heart rate and work rate (WR) at the first and second ventilatory thresholds were measured at start of CR. Training heart rate was measured during three sessions spread over the CR. Multivariate models were used to compare training characteristics between centres and to assess the effect of training intensity on change in peakV˙O2.ResultsTraining intensity was measured in 1011 out of 1633 EU-CaRE patients in 7 of 8 centers and the first and secondary ventilatory threshold were identified in 1166 and 817 patients, respectively. The first and second ventilatory threshold were found at 44% (SD 16%) and 78% (SD 9%) of peak WR and 78% (SD 9%) and 89% (SD 5%) of peak heart rate, respectively. Training intensity and session duration varied significantly between centres but change in peakV˙O2over CR did not. Training above the first individual threshold (β 0.62, 95% confidence interval [0.25–1.02]) and increase in training volume per hour (β 0.06, 95%CI [0.01–0.12]) were associated with a higher change in peakV˙O2.ConclusionWhile training intensity and volume varied greatly amongst current European CR programs, changes in peakV˙O2were similar and the effect of training characteristics on these changes were small.

Published
2020

37. Basic life support training into cardiac rehabilitation programs: A chance to give back. A community intervention controlled manikin study

Author

Carlos Peña-Gil, Carmen Neiro-Rey, Cristian Abelairas-Gómez, Antonio Rodríguez-Núñez, José Ramón González-Juanatey, Violeta González-Salvado, and Roberto Barcala-Furelos

Subjects
Male, Resuscitation, Acute coronary syndrome, medicine.medical_specialty, Education, Continuing, medicine.medical_treatment, education, 030204 cardiovascular system & hematology, Emergency Nursing, Manikins, Random Allocation, 03 medical and health sciences, 0302 clinical medicine, medicine, Humans, 030212 general & internal medicine, Cardiopulmonary resuscitation, Automated external defibrillator, Cardiac Rehabilitation, Rehabilitation, business.industry, Basic life support, Middle Aged, medicine.disease, Cardiopulmonary Resuscitation, Emergency Medicine, Physical therapy, Female, Cardiology and Cardiovascular Medicine, business, Out-of-Hospital Cardiac Arrest, Program Evaluation, Community intervention
Abstract

Aim Early basic life support is crucial to enhance survival from out-of-hospital cardiac arrest but rates remain low, especially in households. High-risk groups’ training has been advocated, but the optimal method is unclear. The CArdiac REhabilitation and BAsic life Support (CAREBAS) project aims to compare the effectiveness of two basic life support educational strategies implemented in a cardiac rehabilitation program. Methods A community intervention study including consecutive patients enrolled on an exercise-based cardiac rehabilitation program after acute coronary syndrome or revascularization was conducted. A standard basic life support training (G-Stan) and a novel approach integrating cardiopulmonary resuscitation hands-on rolling refreshers (G-CPR) were randomly assigned to each group and compared. Basic life support performance was assessed by means of simulation at baseline, following brief instruction and after the 2-month program. Results 114 participants were included and 108 completed the final evaluation (G-Stan:58, G-CPR:50). Basic life support performance was equally poor at baseline and significantly improved following a brief instruction. A better skill retention was found after the 2-month program in G-CPR, significantly superior for safety and sending for an automated external defibrillator. Confidence and self-perceived preparation were also significantly greater in G-CPR after the program. Conclusions Integrating cardiopulmonary resuscitation hands-on rolling refreshers in the training of an exercise-based cardiac rehabilitation program is feasible and improves patients’ skill retention and confidence to perform a basic life support sequence, compared to conventional training. Exporting this formula to other programs may result in increased numbers of trained citizens, enhanced social awareness and bystander resuscitation.

Published
2018

38. Clinical profile and outcomes in octogenarians with atrial fibrillation: A community-based study in a specific European health care area

Author

Alfonso Varela-Román, Ricardo Laje, Carlos Peña-Gil, Estrella López-Pardo, José Ramón González-Juanatey, Pilar Mazón, Jose-Luis Martínez-Sande, Alberto Cordero, Alvaro Martínez-Gomez, María Pereira-Vázquez, José Novo-Platas, Moisés Rodríguez-Mañero, Javier García-Seara, José María García-Acuña, Isabel Moscoso, and Omar Kredieh

Subjects
Adult, Male, medicine.medical_specialty, Adolescent, 030204 cardiovascular system & hematology, Young Adult, 03 medical and health sciences, 0302 clinical medicine, Median follow-up, Octogenarian, Internal medicine, Atrial Fibrillation, medicine, Electronic Health Records, Humans, Dementia, Community Health Services, 030212 general & internal medicine, Young adult, Stroke, Aged, Aged, 80 and over, business.industry, Mortality rate, Atrial fibrillation, Middle Aged, medicine.disease, Europe, Clinical trial, Treatment Outcome, Spain, Heart failure, Physical therapy, Female, Cardiology and Cardiovascular Medicine, business, Follow-Up Studies
Abstract

Background: Age increases risk of stroke and bleeding. Clinical trial data have had relatively low proportions of elderly subjects. We sought to study a Spanish population of octogenarians with atrial fibrillation (AF) by combining different sources of electronic clinical records from an area where all medical centres utilized electronic health record systems. Methods: Data was derived from the Galician Healthcare Service information system. Results: From 383,000 subjects, AF was coded in 7990 (2.08%), 3640 (45.6%) of whom were >= 80 and 4350 (54.4%) = 80, 2178 (59.8%) were women. Mean CHA(2)DS(2)-VASc was 4.2 +/- 1.1. Distribution of CHA(2)DS(2)-VASc components varied between genders. 2600 (71.4%) were on oral anticoagulant (OA). During a median follow up of 696 days (124.23), all-cause mortality was higher in >= 80 (1011/3640 (27.8%) vs 350/4350 (8.05%) (p < 0.001). There were differences in rate of thromboembolic (TE) and haemorrhagic events (2.3% vs 0.9%, p < 0.01 and 2.5% vs 1.7%, p = 0.01 respectively). In octogenarian, differences between genders were observed with regard to TE, but not in haemorrhagic or all-cause mortality rates. Age, heart failure, non-valvular AF, dementia, and OA were independent predictors of all-cause mortality. In regard to TE, female gender, hypertension, previous TE and OA were independent predictive factors. Conclusions: Octogenarians with AF had very different characteristics and outcomes from their younger counterparts. These results also provide reassurance about the effectiveness of OA in preventing TE events and maintaining a reasonable haemorrhagic event rate in the extremely elderly. (C) 2017 Elsevier B.V. All rights reserved.

Published
2017

39. Manejo intervencionista de una insuficiencia mitral por pseudocleft en paciente pluripatológico

Author

Charigan Abou Jokh Casas, José Nicolás López Canoa, Leyre Álvarez Rodríguez, Carlos Peña Gil, María Álvarez Barredo, Ana Belén Cid Álvarez, and María Amparo Martínez Monzonis

Subjects
Pharmaceutical Science
Abstract

Se presenta un caso de insuficiencia cardíaca refractaria a tratamiento médico en paciente pluripatológico con insuficiencia mitral grave por pseudocleft en el que se decide un manejo intervencionista con implante de MitraClip. Este caso destaca la importancia del manejo multidisciplinar de la insuficiencia cardíaca integrando distintas áreas de la cardiología como la clínica, la imagen avanzada y el intervencionismo percutáneo.

Published
2018

40. P2509Less effect of cardiac rehabilitation for elderly cardiac patients with lower educational attainment

Author

I Kjesbu, A.W.J. van't Hof, Carlos Peña Gil, E P De Kluiver, Esther P. Meindersma, E Prescott, Kirstine Lærum Sibilitz, Nicolai Mikkelsen, A E Van Der Velde, Diego Ardissino, M C Iliou, Uwe Zeymer, and Matthias Wilhelm

Subjects
medicine.medical_specialty, Generalized anxiety disorder, Evidence-based practice, Rehabilitation, business.industry, medicine.medical_treatment, medicine.disease, Educational attainment, Patient Health Questionnaire, Diabetes mellitus, Epidemiology, medicine, Physical therapy, Anxiety, medicine.symptom, Cardiology and Cardiovascular Medicine, business
Abstract

Background Previous analyses from EU-CaRE study have shown that elderly cardiac patients with basic education have a greater burden of cardiovascular risk factors and a lower exercise capacity at baseline of cardiac rehabilitation (CR). We hypothesize that participation in CR will diminish this socioeconomic gap. Purpose To describe if educational level predicts the benefits of CR in an elderly population in Europe. Methods The observational EU-CaRE study is a prospective study with eight participating CR centers in seven countries (Denmark, France, Germany, the Netherlands, Italy, Spain and Switzerland). Consecutive patients age 65 or older with coronary heart disease or valve surgery participating in CR were included. Data were obtained at baseline (T0) and at the end of CR (T1) and include risk factors for cardiovascular disease, clinical and psychological assessment, medical treatment and exercise capacity. Patients were divided into basic, intermediate and higher educational levels. We compared changes from T0-T1 by multiple regression models. Results A total of 1621 (99% of included) patients were eligible for follow-up analyses. At baseline patients with basic education had more diabetes, higher BMI, lower exercise capacity (VO2 peak) and higher scores for depression (GAD) and anxiety (PHQ-9). At T1 they had improved significantly less on these parameters. The results were not affected by adjustment for gender, age, country and baseline value of the variable. Use of evidence-based medication did not differ by level of education. Difference between T0 and T1 Factor High Intermediate Basic p-value* N total 1621 N=386 N=775 N=460 BMI, mean (SD) −0.16 (0.71) −0.08 (0.82) −0.26 (0.95) 0.794 LDL (mmol/L), mean (SD) −0.07 (0.63) −0.11 (0.62) −0.04 (0.58) 0.978 HbA1c (mmol/mol), mean (SD) 0.23 (3.70) 0.52 (4.39) 0.04 (5.79) 0.021 GAD score, mean (SD) −0.92 (2.72) −0.76 (3.07) −0.13 (3.47) 0.003 PHQ-9 score, mean (SD) −1.45 (3.21) −1.16 (3.36) −0.93 (4.49) Difference in VO2peak, GAD and PHQ score Conclusions In this large European study with high-quality data from 7 CR centers we found an increased gap disfavoring the lower educated elderly patients participating in CR. These results indicate that “one-size cardiac rehabilitation” does not fit all and indicate that a more personalized CR with attention to the different needs of some patient groups is appropriate. Acknowledgement/Funding Horizon2020

Published
2019

41. P6218Greater burden of risk factors and need of cardiac rehabilitation in elderly patients with lower educational attainment

Author

A E Van Der Velde, E P De Kluiver, Diego Ardissino, M C Iliou, Uwe Zeymer, Nicolai Mikkelsen, Matthias Wilhelm, I Kjesbu, Carlos Peña Gil, Esther P. Meindersma, A.W.J. van't Hof, E Prescott, and Kirstine Lærum Sibilitz

Subjects
Gerontology, Rehabilitation, business.industry, medicine.medical_treatment, Medicine, Cardiology and Cardiovascular Medicine, business, Educational attainment
Abstract

Background A socioeconomic gap in cardiac rehabilitation (CR) has been described in younger populations but whether this is also true in the ageing population is unknown. Purpose To describe if poorer education is a predictor for exercise capacity, comorbidity, lifestyle- and risk factors and medical treatment at baseline in CR in an elderly population. Methods The observational EU-CaRE study is a European prospective study with eight participating CR centers in seven countries (Denmark, France, Germany, the Netherlands, Italy, Spain and Switzerland). Patients aged 65 or older with CHD or valve surgery participating in CR were consecutively included. Educational attainment was divided into basic, intermediate and high Results A total of 1626 patients were included. Educational attainment differed across centers (p Demographics and risk factor control N=1626 High (N=388) Intermediate (N=788) Basic (N=460) p-value* DEMOGRAPHICS Age (yrs), median (IQR) 72 (68, 76) 71 (68, 75) 74 (70, 78) 1.8 mmol/l*** 255 (66.1%) 518 (66.8%) 293 (63.7%) 0.060 Systolic BP >140 mmHg 85 (22.0%) 179 (23.1%) 100 (21.7%) 0.601 Smoker 26 (6.8%) 80 (10.3%) 46 (10.0%) 0.214 Moderate exercise 27 kg/m2 133 (35.5%) 389 (50.2%) 255 (55.4%) 48mmol/mol*** 115 (29.8%) 264 (34.1%) 230 (50.0%) Conclusions The results emphasize the need of CR in this patient-group and that a targeted CR approach should be considered to achieve equal health opportunities also in the elderly. Acknowledgement/Funding Horizon2020

Published
2019

42. Very brief training for laypeople in hands-only cardiopulmonary resuscitation. Effect of real-time feedback

Author

José Ramón González-Juanatey, Antonio Rodríguez-Núñez, Felipe Fernández-Méndez, Carlos Peña-Gil, Violeta González-Salvado, and Roberto Barcala-Furelos

Subjects
Adult, Male, medicine.medical_specialty, Time Factors, Formative Feedback, medicine.medical_treatment, Pilot Projects, Visual feedback, 030204 cardiovascular system & hematology, Manikins, Quality performance, Hand position, 03 medical and health sciences, 0302 clinical medicine, Health care, Humans, Medicine, Bystander cardiopulmonary resuscitation, Cardiopulmonary resuscitation, Motivation, business.industry, 030208 emergency & critical care medicine, General Medicine, Cardiopulmonary Resuscitation, Emergency Medicine, Physical therapy, Female, business, Out-of-Hospital Cardiac Arrest, Performance quality
Abstract

Background Bystander cardiopulmonary resuscitation (CPR) improves survival from out-of-hospital cardiac arrest, but rates and performance quality remain low. Although training laypeople is a primary educational goal, the optimal strategy is not well defined. This study aimed to determine whether a short training with real-time feedback was able to improve hands-only CPR among untrained citizens. Methods On the occasion of the 2015 World Heart Day and the European Restart a Heart Day, a pilot study involving 155 participants (81 laypeople, 74 health care professionals) was conducted. Participants were invited to briefly practice hands-only CPR on a manikin and were after evaluated during a 2-minute chest compression (CC) test. During training brief instructions regarding hand position, compression rate and depth according to the current guidelines were given and real-time feedback was provided by a Laerdal SkillReporting System. Results Mean CC rate was significantly higher among health care professionals than among laypeople (119.07 ± 12.85 vs 113.02 ± 13.90 min −1 ; P = .006), although both met the 100-120 CC min −1 criterion. Laypeople achieved noninferior results regarding % of CC at adequate rate (51.46% ± 35.32% vs health care staff (55.97% ± 36.36%; P = .43) and depth (49.88% ± 38.58% vs 50.46% ± 37.17%; P = .92), % of CC with full-chest recoil (92.77% ± 17.17% vs 0.91% ± 18.84; P = .52), and adequate hand position (96.94% ± 14.78% vs 99.74 ± 1.98%; P = .11). The overall quality performance was greater than 70%, noninferior for citizens (81.23% ± 20.10%) vs health care staff (85.95% ± 14.78%; P = .10). Conclusion With a very brief training supported by hands-on instructor-led advice and visual feedback, naive laypeople are able to perform good-quality CC-CPR. Simple instructions, feedback, and motivation were the key elements of this strategy, which could make feasible to train big numbers of citizens.

Published
2016

43. Mehran contrast nephropathy risk score: Is it still useful 10 years later?

Author

Raymundo Ocaranza-Sánchez, Sergio Raposeiras-Roubín, Carlos Peña-Gil, Violeta González-Salvado, Rocío González-Ferreiro, José Ramón González-Juanatey, Rosa A. Abellás-Sequeiros, J.M. García-Acuña, Diego Iglesias-Álvarez, Alfredo Redondo-Diéguez, and Emad Abu-Assi

Subjects
Male, medicine.medical_specialty, Acute coronary syndrome, Anemia, Contrast Media, Renal function, 030204 cardiovascular system & hematology, Coronary Angiography, Risk Assessment, Nephropathy, Contrast nephropathy, 03 medical and health sciences, 0302 clinical medicine, Predictive Value of Tests, Risk Factors, Internal medicine, Diabetes mellitus, Odds Ratio, medicine, Health Status Indicators, Humans, 030212 general & internal medicine, Acute Coronary Syndrome, Aged, Aged, 80 and over, Framingham Risk Score, business.industry, Acute Kidney Injury, Middle Aged, medicine.disease, Surgery, ROC Curve, Spain, Cohort, Cardiology, Female, business, Cardiology and Cardiovascular Medicine
Abstract

Nowadays, contrast-induced nephropathy (CIN) is the third cause of acquired acute renal impairment in hospital. CIN is related to increased in-hospital morbidity, mortality, costs of medical care, and long admissions. Because of this, we hypothesized it would be useful to determine the risk of CIN with scores such as the Mehran score. The aim of this study was to validate the Mehran score in a contemporary cohort of Spanish patients with acute coronary syndrome (ACS).We assessed the calibration and discriminatory capacity of Mehran score to predict CIN in a cohort of 1520 patients with a definitive diagnosis of ACS and who underwent coronary angiography between March 2008 and June 2012. We excluded patients on chronic dialysis and those without data of contrast volume. The calibration of the model was assessed with the Hosmer-Lemeshow goodness-of-fit test and discriminatory capacity was assessed by C-statistic, which is equivalent to the area under the receiver-operating characteristic curve.From the total group, 118 patients (7.8%) developed CIN. They were older, with higher rates of diabetes (DM) and hypertension and worse renal function and anemia (p0.001). The odds ratios for different score components in Mehran's population versus our study were similar except for DM, hypotension, and intra-aortic balloon pump (1.6%, 2.68%, 2.55% vs 0.9%, 1.89%, and 2.86%, respectively). Calibration and discriminatory capacity of Mehran score were excellent with a Hosmer-Lemeshow p=0.7, C-statistic value0.8.Mehran risk score has been validated in our study as a good score for predicting CIN in patients with ACS who underwent coronary angiography. According to this, we support its use in patients hospitalized for ACS in order to identify the ones at risk, and to optimize CIN prophylactic therapy prior to and after catheterization.

Published
2016
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44. The Risk of Cardiovascular Events After an Acute Coronary Event Remains High, Especially During the First Year, Despite Revascularization

Author

Andrea López-López, José María García-Acuña, José Ramón González-Juanatey, Rami Riziq-Yousef Abumuaileq, Noelia Bouzas-Cruz, Violeta González-Salvado, Sergio Raposeiras-Roubín, Emad Abu-Assi, Alfredo Redondo-Diéguez, and Carlos Peña-Gil

Subjects
Male, Acute coronary syndrome, medicine.medical_specialty, Time Factors, medicine.medical_treatment, Myocardial Infarction, Infarction, 030204 cardiovascular system & hematology, Revascularization, Risk Assessment, 03 medical and health sciences, 0302 clinical medicine, Risk Factors, Internal medicine, Myocardial Revascularization, medicine, Humans, Registries, 030212 general & internal medicine, Myocardial infarction, Acute Coronary Syndrome, Stroke, Aged, Retrospective Studies, business.industry, Incidence, Incidence (epidemiology), Retrospective cohort study, General Medicine, medicine.disease, Survival Rate, Spain, Cardiology, Female, business, Risk assessment, Follow-Up Studies
Abstract

There is little information on the incidence and predictors of infarction, stroke, or cardiovascular death after acute coronary syndrome. We investigated these aspects and developed tools for predicting these events according to the time of their occurrence.A retrospective study was conducted of 4858 patients who survived an acute coronary event. We analyzed the incidence and predictors of acute myocardial infarction, stroke, or cardiovascular death during the first year (n=4858) vs successive years (n=4345 patients free of composite events during the first year).There were 329 events in the first year (cumulative incidence function: 7.3% person-years) and 616 in successive years (21.5% person-years; follow-up 4.9±2.4 years). The risk of events during the first year per tertile was 2.5% person-years in the low-risk tertile (3 points), 4.8% person-years in the intermediate-risk tertile (3-6 points), and 15.5% person-years in the high-risk tertile (6 points) (P.001). The risk of events in the cohort that had a combined event in successive years increased from 10.7% person-years in the low-risk tertile (3 points) to 40.3% person-years in the high-risk tertile (6 points) (P.001). The 2 scales showed the following predictive indexes: C statistic, 0.74 and 0.69, respectively; P (Hosmer-Lemeshow test)≥0.44 CONCLUSION: The risk of recurrence of cardiovascular events remains high after acute coronary syndrome. The level of risk can be easily quantified with acceptable predictive ability.

Published
2016

45. Dominancia coronaria y pronóstico a largo plazo de los pacientes con infarto de miocardio con elevación del segmento ST tratado con angioplastia primaria

Author

Violeta González-Salvado, Carlos Peña-Gil, Pedro Rigueiro-Veloso, Rami Riziq-Yousef Abumuaileq, Sergio Raposeiras-Roubín, José Ramón González-Juanatey, María Castiñeira-Busto, Emad Abu-Assi, Raimundo Ocaranza, and José María García-Acuña

Subjects
03 medical and health sciences, 0302 clinical medicine, business.industry, Medicine, 030212 general & internal medicine, 030204 cardiovascular system & hematology, Cardiology and Cardiovascular Medicine, business, Humanities
Abstract

Introduccion y objetivos El significado pronostico a largo plazo del patron de dominancia coronaria en pacientes con infarto de miocardio con elevacion del segmento ST esta mal caracterizado. Se investigo el pronostico de esos pacientes segun tuvieran dominancia derecha, izquierda o codominancia. Metodos Estudio retrospectivo de 767 pacientes, ingresados entre 2007 y 2012 por infarto de miocardio con elevacion del segmento ST y tratados con intervencionismo coronario percutaneo primario. Se determino el impacto del patron de dominancia coronaria, en la mortalidad por cualquier causa y los reingresos por infarto ajustando por mortalidad como evento competitivo. Resultados La dominancia coronaria fue derecha en el 80,9% e izquierda en el 8,6%. Durante 40,8 [intervalo intercuartilico, 21,9-58,3] meses de seguimiento, se registraron 118 (15,4%) muertes, 39 (5,1%) de ellas, intrahospitalarias. La mortalidad fue del 7,1, el 36,4 y el 13,8% (p < 0,001) en dominancia derecha, izquierda y codominancia, respectivamente. La causa de muerte fue cardiovascular en el 7,1, el 21,2 y el 2,4%. En el analisis multivariable de Cox, la dominancia izquierda se asocio significativamente con la mortalidad (hazard ratio = 1,76; p = 0,02). Considerar «dominancia coronaria» en la prediccion de riesgo de muerte mejoro la capacidad de discriminacion y calibracion de la puntuacion GRACE (Global Registry of Acute Coronary Events). El 9,3% (71 pacientes) presento reinfarto durante el seguimiento. En el analisis multivariable, la dominancia izquierda fue predictora independiente de reinfarto (sub-hazard ratio = 2,06; p = 0,01). Conclusiones En el infarto con elevacion del segmento ST tratado con intervencionismo coronario percutaneo primario, la dominancia izquierda confiere mayor riesgo de muerte y reinfarto que la dominancia derecha, y deberia tenerse en cuenta en la estratificacion pronostica.

Published
2016

46. Coronary Artery Dominance and Long-term Prognosis in Patients With ST-segment Elevation Myocardial Infarction Treated With Primary Angioplasty

Author

Carlos Peña-Gil, Sergio Raposeiras-Roubín, Emad Abu-Assi, José María García-Acuña, Violeta González-Salvado, Raimundo Ocaranza, José Ramón González-Juanatey, María Castiñeira-Busto, Pedro Rigueiro-Veloso, and Rami Riziq-Yousef Abumuaileq

Subjects
medicine.medical_specialty, business.industry, medicine.medical_treatment, Hazard ratio, Infarction, Percutaneous coronary intervention, General Medicine, 030204 cardiovascular system & hematology, medicine.disease, 03 medical and health sciences, 0302 clinical medicine, Left coronary artery, Interquartile range, Internal medicine, medicine.artery, Right coronary artery, medicine, Cardiology, 030212 general & internal medicine, Myocardial infarction, business, Cause of death
Abstract

Introduction and objectives The long-term prognostic significance of coronary artery dominance pattern in patients with ST-segment elevation myocardial infarction is poorly characterized. We investigated the prognosis of such patients according to whether they had right dominance, left dominance, or codominance . Methods This was a retrospective study of 767 patients, who were admitted to hospital between 2007 and 2012 with ST-segment elevation myocardial infarction and treated with primary percutaneous coronary intervention . We determined the effect of the coronary dominance pattern on all-cause mortality and readmission for infarction, adjusting for mortality as a competing event. Results A total of 80.9% of patients had right coronary dominance, and 8.6% had left coronary dominance. Over 40.8 months’ [interquartile range, 21.9-58.3 months] follow-up, 118 (15.4%) deaths were recorded, of which 39 (5.1%) were in hospital. Mortality for right dominance, left dominance, and codominance was 7.1%, 36.4%, and 13.8% (P ˂ .001), respectively. Cause of death was cardiovascular in 7.1%, 21.2%, and 2.4%. On Cox multivariate analysis , left dominance was significantly associated with mortality (hazard ratio = 1.76; P = .02). Taking “coronary dominance” into account in prediction of risk of death improved the discrimination and calibration capacity of GRACE (Global Registry of Acute Coronary Events) scoring. At follow-up, 9.3% (71 patients) had reinfarction. On multivariate analysis , left dominance was an independent predictor of reinfarction (subhazard ratio = 2.06; P = .01). Conclusions In ST-segment elevation myocardial infarction treated with primary percutaneous coronary intervention, left coronary artery dominance confers a higher risk of death and reinfarction than right coronary artery dominance, and should be included in prognostic stratification.

Published
2016

47. El riesgo de eventos cardiovasculares tras un evento coronario agudo persiste elevado a pesar de la revascularización, especialmente durante el primer año

Author

Andrea López-López, José María García-Acuña, Rami Riziq-Yousef Abumuaileq, Noelia Bouzas-Cruz, Carlos Peña-Gil, Emad Abu-Assi, Violeta González-Salvado, José Ramón González-Juanatey, Alfredo Redondo-Diéguez, and Sergio Raposeiras-Roubín

Subjects
03 medical and health sciences, 0302 clinical medicine, business.industry, Medicine, 030212 general & internal medicine, 030204 cardiovascular system & hematology, Cardiology and Cardiovascular Medicine, business, Humanities
Abstract

Resumen Introduccion y objetivos Existe escasa informacion sobre la incidencia y los predictores de infarto, ictus o muerte cardiovascular tras presentar un sindrome coronario agudo. Se investigaron los aspectos previos y se desarrollaron herramientas de prediccion de dichos eventos segun la temporalidad de su ocurrencia. Metodos Estudio retrospectivo de 4.858 pacientes supervivientes a un evento coronario agudo. Se analizo la incidencia y los predictores de infarto agudo de miocardio, ictus o muerte cardiovascular durante el primer ano (n = 4.858) frente a anos sucesivos (n = 4.345 pacientes libres del evento combinado durante el primer ano). Resultados En el primer ano hubo 329 eventos (funcion de incidencia acumulada, 7,3% personas-ano) y 616 posteriormente (21,5% personas-ano; seguimiento de 4,9 ± 2,4 anos). El riesgo de eventos durante el primer ano en los terciles de riesgo establecidos fue del 2,5% personas-ano en el grupo de riesgo bajo ( 6 puntos) (p 6 puntos) (p C , 0,74 y 0,69 respectivamente; p (test de Hosmer-Lemeshow) ≥ 0,44. Conclusiones Persiste un riesgo elevado de recidiva de eventos cardiovasculares despues de un sindrome coronario agudo. Es posible cuantificar dicho riesgo de manera sencilla y con aceptable capacidad predictiva.

Published
2016

48. A community intervention study on patients' resuscitation and defibrillation quality after embedded training in a cardiac rehabilitation program

Author

José Ramón González-Juanatey, Carlos Peña-Gil, Carmen Neiro-Rey, Cristian Abelairas-Gómez, Violeta González-Salvado, Roberto Barcala-Furelos, and Antonio Rodríguez-Núñez

Subjects
Adult, Male, medicine.medical_specialty, Resuscitation, Defibrillation, medicine.medical_treatment, education, Electric Countershock, Coronary Disease, Education, law.invention, 03 medical and health sciences, Heart disorder, 0302 clinical medicine, Randomized controlled trial, Patient Education as Topic, law, health services administration, Medicine, Humans, cardiovascular diseases, 030212 general & internal medicine, Cardiopulmonary resuscitation, Community Health Services, health care economics and organizations, 030505 public health, Rehabilitation, Cardiac Rehabilitation, business.industry, Public Health, Environmental and Occupational Health, Basic life support, Middle Aged, Cardiopulmonary Resuscitation, Self Concept, Exercise Therapy, Physical therapy, Female, 0305 other medical science, business, therapeutics, First aid
Abstract

The aim of this study was to examine the effectiveness of a novel cardiopulmonary resuscitation (CPR) training method embedded in a cardiac rehabilitation program at enhancing patients' CPR and defibrillation skills. One hundred and fourteen participants with coronary heart disease enrolled on an exercise-based cardiac rehabilitation program were included. Two groups were randomly allocated to different training programs: CPR-retraining based on hands-on rolling refreshers during the 2-month program (G-CPR, n = 53) versus standard one-time training (G-Stan, n = 61). Resuscitation and defibrillation skills and self-confidence were evaluated at baseline, following brief basic life support (BLS) instruction and after the distinct training programs. Baseline skills were equally poor, improving significantly although irregularly after brief instruction. After the program, CPR quality was further enhanced in G-CPR, which achieved better results regarding correct compressions by depth, rate, hands position and global CPR quality (P < 0.01, all analysis). Defibrillation skills improved similarly after instruction and were reasonably maintained after the program, although delay to shock was reduced in G-CPR. CPR self-confidence was superior in G-CPR (P < 0.001). In conclusion, CPR hands-on rolling refreshers embedded into an exercise-based cardiac rehabilitation program enhanced patients' CPR and defibrillation skills and self-confidence to perform CPR at 2 months, compared with standard one-time training. This method could help to bring effective training to high-risk populations.

Published
2018

49. Relevance of Dementia in Atrial Fibrillation Patients within a Specific European Health Care Area

Author

Moisés Rodríguez-Mañero, Alberto Ruano, José Ramón González-Juanatey, Javier García-Seara, Estrella López-Pardo, Alberto Cordero, José María García-Acuña, Carlos Peña-Gil, Pilar Mazón, Jose-Luis Martínez-Sande, Adrián Cid-Menéndez, Omar Kreidieh, Luis Valdés, María Pereira-Vázquez, and José Novo Platas

Subjects
Male, medicine.medical_specialty, CHA(2)DS(2)-VASc, Epidemiology, Comorbidity, 030204 cardiovascular system & hematology, Risk Assessment, 03 medical and health sciences, Big data, 0302 clinical medicine, Thromboembolism, Internal medicine, Atrial Fibrillation, Health care, medicine, Humans, Dementia, In patient, Registries, Prospective cohort study, Stroke, Aged, Aged, 80 and over, business.industry, Atrial fibrillation, Prognosis, medicine.disease, Europe, Survival Rate, Cohort, Propensity score matching, Female, Neurology (clinical), business, 030217 neurology & neurosurgery
Abstract

Introduction: Atrial fibrillation might increase the risk of dementia. We aim to test the hypothesis that dementia could reclassify the actual risk of stroke and death predicted by the CHA2DS2-VASc in patients with atrial fibrillation (AF). Methods: A prospective study performed in a specific health care area. Results: From our health care area (n = 348,985), throughout 2013, AF was codified in 7,990 (2.08%). Mean age was 76.83 ± 10.5, mean CHA2DS2-VASc = 3.5, 4,056 (50.8%) were females and 287 (3.6%) were diagnosed to have dementia. Patients with dementia were older and presented a higher rate of all the components of the CHA2DS2-VASc-expect vasculopathy. Differences in overall mortality were observed but not in stroke and haemorrhagic events. After propensity score matched analysis, dementia was independently associated with all-cause mortality. Addition of dementia to CHA2DS2-VASc reclassified 7.7 and 16.6% of the cohort with regard to thromboembolic events and death risk respectively. Conclusions: Patients with dementia presented a more adverse risk profile, with significant differences in all-cause mortality.

Published
2018

50. Pronóstico a largo plazo de pacientes con infarto agudo de miocardio sin elevación del segmento ST y arterias coronarias sin estenosis significativa

Author

Alfredo Redondo-Diéguez, Ozoda Saidhodjayeva, Rocío González-Ferreiro, Emad Abu-Assi, Andrea López-López, Carlos Peña-Gil, Sergio Raposeiras-Roubín, José Ramón González-Juanatey, José María García-Acuña, and María Castiñeira-Busto

Subjects
business.industry, Medicine, Cardiology and Cardiovascular Medicine, business, Humanities
Abstract

Resumen Introduccion y objetivos El significado pronostico de la ausencia de lesiones coronarias significativas en pacientes con infarto agudo de miocardio sin elevacion del segmento ST es motivo de controversia. Se investigo en una cohorte contemporanea el pronostico a largo plazo de esos pacientes. Metodos Estudio observacional retrospectivo de 5.203 pacientes con sindrome coronario agudo. Mediante propensity score matching , se obtuvieron dos grupos de 367 pacientes con infarto agudo de miocardio sin elevacion del segmento ST apareados por la ausencia o presencia de lesiones coronarias significativas. En la cohorte apareada, se determino el impacto de la ausencia de lesiones coronarias significativas en mortalidad o reingresos por sindrome coronario agudo durante 4,8 ± 2,6 anos despues del alta. Resultados La mortalidad o el reingreso por sindrome coronario agudo fueron menos entre los pacientes sin lesiones significativas (el 26,4 frente al 32,7%; p = 0,09). La mortalidad en ambos grupos fue del 19,1%. En cambio, los pacientes sin lesiones significativas presentaron menor incidencia de reingreso por sindrome coronario agudo: 2,0 frente a 3,9/100 personas-ano; p = 0,003). La incidencia de muerte o reingreso por sindrome coronario agudo fue similar entre los pacientes sin lesiones y enfermedad significativa de un vaso (el 26,4 frente al 27,5%; p = 0,19), aunque mas baja que la observada en pacientes con afeccion de dos vasos (37,8%; p = 0,007) y tres vasos/tronco comun izquierdo (41,1%; p = 0,002). Conclusiones Los pacientes con infarto agudo de miocardio sin elevacion del segmento ST y coronarias sin lesiones presentan similar mortalidad a largo plazo que el grupo con lesiones significativas, pero reingresan menos frecuentemente por sindrome coronario agudo. La mortalidad o reingreso por sindrome coronario agudo de pacientes sin lesiones es similar que con enfermedad de un vaso, pero menor que en la de dos o mas vasos.

Published
2015

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