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The utilization of cardiovascular rehabilitation (CR) programmes in patients with Lower Extremity Peripheral Artery Disease (LEPAD) is generally poor, with limited evidence of current policies for referral. The aim of the study was to evaluate, within a cohesive network of CR and vascular surgery facilities with facilitated referral process, the clinical characteristic of LEPAD patients referred to CR and related outcomes, as compared to patients not referred. The present is an observational prospective study of consecutive patients recruited at vascular surgery facilities. Out of 329 patients observed, the average referral rate to CR was 34% (28% and 39% in patients with and without recent peripheral revascularization, p

Introduction: The cardio-rehabilitation after acute myocardial infarction (AMI) is able to determine prognostic, hemodynamic and functional heart improvement. The 6-minute-walking-test Distance (6MWTD) is well known as prognostic and functional markers after AMI. Aim: To evaluate a new parameter (6MWTD/Heart Rate-HR) at the beginning (t0) of the cardio-rehabilitation could better predictthe final exercise capacity in patients with a recent AMI. Methods: We studied 34 patients (age 61 ± 10 years; 30 male) with the 6MWT at t0 and at the end of the rehabilitation program (after 20–25 session, t1) together with an ergometric test. Results: At t0 the Blood Pressure (BP) was 124/77 ± 15/ 6 mmHg, HR 63 ± 11 bpm and Ejection Fraction (EF) 55 ± 7 %. At the 6MWT the walked distance was 455 ± 100 m, with a max HR of 95 ± 13 (60 ± 9 % of the theoretical max HR). The 6MWTD/HR ratio was 4.8 ± 1. At the end of the rehabilitation program systolic BP was significantly reduced (112 ± 9 mmHg) and the walked distance increased (583 ± 106 m, 110 ± 21 % of the theoretical max HR). 6MWTD/HR at t0 significantly correlates with walked distance and the theoretical max HR at t1 (r = 0.67, p\0.001 and r = 0.53, p 0.001, respectively) and with the reached watt at the ergometric test (r = 0.57, \0.001). Nor the echocardiographic parameter or the HR and the BP correlate at t0 or at t1 with 6MWTD/HR ratio. Conclusions: The 6MWTD/HR ratio at t0 is a new index that correlates with the functional capacity at the end of the rehabilitation. It could be useful to set the program itself and as a predictor of functional outcome.

INTRODUCTION: Lifestyle change is a main goal of primary and secondary prevention in cardiovascular disease (CVD). Recent studies showed that a personalized communication, tailored on patients’ needs, preferences, and psychological characteristics, is more effective in promoting behavioral change compared to a generic communication. AIM: Of our study are: to investigate patients’ psychological characteristics, to identify types of patients through the clusterization of these characteristics; to verify the effectiveness of tailored vs. generic communication. METHODS: We plan to enroll 50 patients undergoing a cycle of CV rehabilitation after an acute coronary syndrome or MI. Psychological characteristics, lifestyle, and information needs/preferences are assessed through questionnaire. Patients are then randomly assigned to two groups, respectively receiving through ordinary mail generic and tailored informative brochures focused on lifestyle changes. Patients are then interviewed to test the effectiveness of the two kinds of brochures. RESULTS: We expect to identify types of patients differently characterized in terms of lifestyle, information needs and clinical condition; to confirm the higher effectiveness, in terms of understanding, utility and pleasantness, of tailored brochures compared to generic ones. CONCLUSIONS: This cross-sectional study will contribute to the personalization of CVD management toward a more effective and patient-oriented health care.

Introduction Cardiac rehabilitation (CR) is an effective tool for secondary prevention after acute coronary syndrome (ACS). Aim Aim of our study was to find the significant determinants of exercise capacity (evaluated with the six-minute walking test—6-MWT) and functional improvement in patients undergoing CR after an ACS. Methods The study group included 298 patients (mean age 61.6 ± 10.2 years; males 80.2%) who, after ACS, were enrolled in CR program at Niguarda Hospital in Milan from 2015 to 2018. For all patients, we collected anamnestic, clinical and instrumental cardiological data. All patients performed a 6-MWT at the beginning (6-MWT-1) and at the end (6-MWT-2) of CR program. Δ meters were used to represent functional improvement. Results Multiple linear regression models were carried out for 6-MWT-1, 6-MWT-2, Δ meters and % Δ meters. Standardized regression coefficients showed that age (β = − 0.237; p < 0.001), BMI (β = − 0.116; p = 0.006) and heart rate (β = − 0.082; p = 0.040) were determinants of exercise capacity (6MWT-1 and 2), whereas age (β = −.231; p = 0.004), sex (β = − 0.187; p = 0.008) and BMI (β = − 0.164; p = 0.022) were determinants of functional improvement (Δ meters). Conclusions Our data showed that functional improvement after CR in ACS patients is mainly related to non-cardiological variables. Instead it is related to intrinsic factors, both modifiable (BMI) and non-modifiable (age, sex). Supplementary Information The online version contains supplementary material available at 10.1007/s40292-021-00473-7.

Background and aims: Metabolic Syndrome (MS) has been related to an impairment in arterial structural and functional properties with heterogeneous results. In this paper we focused on the effects of MS on arterial carotid-femoral PWV and common carotid IMT in two different populations, one of hypertensive patients and one of healthy controls. Methods and results: We enrolled 816 consecutive HT and 536 healthy controls. Vascular structural (IMT) and functional (PWV) properties were evaluated. NCEP-ATP-III criteria were used for diagnosis of MS. MS was diagnosed in 26.9% and 6.9% in hypertensive and control subjects, respectively. PWV was similar in controls with and without MS (7.7 ? 1.9 vs 7.6 ? 1.1 m/s, p = 0.69), while IMT was higher in controls with than those without MS (0.64 ? 0.18 vs 0.57 ? 0.13 mm, p = 0.02). Hypertensives with MS were older (57.9 ? 12.2 vs 52.7 ? 14.1 years, p < 0.001) and showed higher PWV (9.0 ? 2.3 vs 8.4 ? 2.1 m/s, p = 0.001) and IMT (0.72 ? 0.22 vs 0.65 ? 0.17 mm, p < 0.001) than those without MS, however at the age-adjusted analysis only the difference in IMT was confirmed (p = 0.007). Regression models showed that MS was an independent determinant of IMT in both controls (13 = 0.08, p = 0.03) and hypertensives (13 = 0.08, p = 0.01), but not of PWV either in controls (13 = 0.006, p = 0.886 and 13 = 0.04, p = 0.19, respectively). Conclusions: the main finding of our work is that MS is a significant determinant of IMT while this is not the case for PWV. This result have been confirmed both in hypertensive subjects and in healthy controls. ? 2020 The Italian Diabetes Society, the Italian Society for the Study of Atherosclerosis, the Italian Society of Human Nutrition and the Department of Clinical Medicine and Surgery, Federico II University. Published by Elsevier B.V. All rights reserved.

Il capitolo esamina la disciplina della tutela dei lavoratori in caso di infortunio dovuto al coronavirus

Introduction: Cardiac rehabilitation (CR) improves the functional capacity and the prognosis of patients with coronary artery disease. Aim: Our study was aimed at assessing the relationship between functional improvement (evaluated with 6-min Walk Test—6MWT) and the improvement in left ventricular ejection fraction (LVEF) after CR. Methods: We collected data from 249 patients (age 66.79 ± 11.06 years; males 81.52%) with a recent history of Acute Coronary Syndrome that performed CR. The functional improvement after CR was expressed as the Δ between distance covered at the final versus the initial 6-min Walking Test (6-MWT), while LVEF was calculated with transthoracic echocardiogram at the beginning and at the end of the CR. Results: Patients were divided accordingly to their pre-rehab LVEF (≥ 55% vs < 55%). With superimposable age and baseline 6MWT distance covered (434.58 vs 405.12 m, p = 0.08), the latter group presented higher Δ meter values at 6MWT (167.93 vs 193.97 m, p = 0.018). However, no statistically significant positive correlation between Δ meters and Δ LVEF was found. Moreover, linear regression analyses found that nor baseline LVEF nor Δ LVEF were significant determinants of Δ meters when considering the whole group, with age, basal 6MWT and peak CK-MB as additional covariates in the model. Conclusion: Although it could be expected that an increase in LVEF is related to the functional improvement after CR, no significant correlation was found in our population.

Introduction: Cardiac rehabilitation (CR) improves the functional capacity and the prognosis of patients with coronary artery disease (CAD). Similar results have also been found in patients with dilated cardiomyopathy (DCM). Aim: To assess the relationship between functional improvement (evaluated with 6-minute walking test–6MWT) and the improvement in left ventricular ejection fraction (LVEF) after CR. Methods: we collected data from 260 patients that performed CR after an Acute Coronary Syndrome (ACS). The functional improvement after CR was expressed as the Δ between distance covered at the final versus the initial 6MWT normalized for the initial 6MWT, while LVEF was calculated with transthoracic echocardiogram at the beginning and at the end of the CR. Results: in the whole population functional improvement was 44.07% (baseline 6MWT 421.22 m vs follow-up 6MWT 597.28 m, p ≤ 0.05) while EF improvement was 2.48% (baseline EF 53.37% vs follow-up EF 55.91%, p ≤ 0.05). No significant correlation between the normalized Δmeter and ΔEF was founded. When patients were divided accordingly to their pre-rehab LVEF (≥ 55, 40–55 and

Many studies have focused on Type A and Type D personality types in the context of cardiovascular diseases (CVDs), but nothing is known about how these personality types combine to create new profiles. The present study aimed to develop a typology of Type A and Type D personality in two groups of patients affected by and at risk for coronary disease. The study involved 711 patients: 51.6% with acute coronary syndrome, 48.4% with essential hypertension (mean age = 56.4 years; SD = 9.7 years; 70.7% men). Cluster analysis was applied. External variables, such as socio-demographic, psychological, lifestyle, and clinical parameters, were assessed. Six groups, each with its own unique combined personality profile scores, were identified: Type D, Type A-Negatively Affected, Not Type A-Negatively Affected, Socially Inhibited-Positively Affected, Not Socially Inhibited, and Not Type A-Not Type D. The Type A-Negatively Affected cluster and, to a lesser extent, the Type D cluster, displayed the worst profile: namely higher total cardiovascular risk index, physical inactivity, higher anxiety and depression, and lower self-esteem, optimism, and health status. Identifying combined personality profiles is important in clinical research and practice in cardiovascular diseases. Practical implications are discussed.