Search

Background: Keeping patients active is an essential goal of cardiac rehabilitation (CR). This research aims to analyze the development of steps/day after CR.Methods: 126 adult, stable cardiac patients who had completed treatment for their acute condition, usually acute coronary syndrome or heart failure, were enrolled during CR and advised for daily step recording up to one year post CR. Mean number of steps during and for 3 weeks post CR were compared by paired t-test. Furthermore, influence of gender, age, smoking, NYHA, EF, BMI, day of the year, and length of time post CR on steps/day were estimated using a generalized additive regression model.Results: Compared to CR, steps/day increased on average by 925steps/day in the first 3 weeks (p0.05), whereas seasonal correlations existed, indicating a summer increase and a winter decline (p

Sinann Al Najem,1,2 Andreas Groll,3,4 Axel Schmermund,5,6 Bernd Nowak,5,6 Thomas Voigtländer,5,6 Ulrike Kaltenbach,5 Peter Dohmann,5 Dietrich Andresen,7 Jürgen Scharhag2,8 1German Heart Foundation, Frankfurt, Germany; 2Institute of Sports and Preventive Medicine, Saarbrücken, Germany; 3Chair of Statistics, Georg August University, Göttingen, Germany; 4Faculty of Statistics, Technical University Dortmund, Dortmund, Germany; 5Cardioangiologisches Centrum Bethanien Herzwerk, Frankfurt, Germany; 6Bethanien Krankenhaus, Cardioangiologisches Centrum Bethanien, Frankfurt, Germany; 7Lutheran Hospital Hubertus, Berlin, Germany; 8Outpatients’ Clinic for Prevention, Rehabilitation and Sports Medicine, Technical University of Munich, Munich, Germany Background: A total of 6,500 to 8,000 steps per day are recommended for cardiovascular secondary prevention. The aim of this research was to examine how many steps per day patients achieve during ambulant cardiac rehabilitation (CR), and if there is a correlation between the number of steps and physical and cardiological parameters. Methods: In all, 192 stable CR patients were included and advised for sealed pedometry. The assessed parameters included maximum working capacity and heart rate, body mass index (BMI), New York Heart Association (NYHA) class, ejection fraction (EF), coronary artery disease status, beta-blocker medication, age, sex, smoking behavior, and laboratory parameters. A regularized regression approach called least absolute shrinkage and selection operator (LASSO) was used to detect a small set of explanatory variables associated with the response for steps per day. Based on these selected covariates, a sparse additive regression model was fitted. Results: The model noted that steps per day had a strong positive correlation with maximum working capacity (P=0.001), a significant negative correlation with higher age (P=0.01) and smoking (smoker: P40: 6,077±1,567). Conclusion: Walking activity during CR is reduced in patients who are unfit, older, smoke, or used to smoke. In addition to training recommendations, estimated steps per day during CR could be seen as a baseline orientation that helps patients to stay generally active or even to increase activity after CR. Keywords: step recommendation, steps/day in cardiac patients, pedometer

Whether a dopamine-deficiency syndrome in a Parkinson-syndrome (PS) may occur more easily during a heat wave than during more temperate climate conditions is unknown. We report a case that may suggest this. A 56 yo male with heterozygosity for metachromatic leucodystrophy and a history of metabolic myopathy, PS and diabetes experienced worsening of the PS during a heat wave. His condition further deteriorated upon reduction of ropinirol, resulting in hyperthermia, respiratory insufficiency, rhabdomyolysis, and severe thrombocytopenia. One month later he was alert but tetraplegic and required ventilatory support. Hyper-CK-emia returned to similar levels as before rhabdomyolysis. Reduction of dopamine agonists during a heat wave may induce a dopamine deficiency syndrome with hyperthermia, rhabdomyolysis and thrombocytopenia.

A 62-year-old woman with mild dyspnea on exertion underwent coronary angiography. A large fistula of the left circumflex artery was found but the exit site of this unusual anomaly could not be established. Contrast-enhanced multidetector computed tomography of the coronary arteries was performed which allowed clear identification of the drainage of the fistula into the superior vena cava.

Background: Definite diagnosis of prion diseases or transmissible spongiform encephalopathies (TSEs) requires neuropathology, usually at autopsy. Epidemiology of human TSEs has relied on definite as well as 'probable' cases in which neuropathological confirmation is lacking, usually because of low autopsy rates in most countries., Methods: In Austria, an active surveillance program for human prion diseases was established in 1996. Since then, more than 900 referrals were analyzed. Postmortem investigation of brain tissue is mandatory in every suspect case of TSE. Thus, epidemiological data on TSEs from Austria may serve as autopsy-controlled reference for countries with lower autopsy rates., Results: The total number of TSE cases in Austria since 1969 is 206. The average yearly mortality for the active surveillance period from 1996 to 30 June 2006 is 1.39 per million, with the highest rates for Vienna (2.37) compared with other provinces. Eighty-five percent of definite TSEs were classified as sporadic Creutzfeldt-Jakob disease (sCJD). We observed a significant linear increase in the mean age at death of 0.6 years per calendar year. Clinical diagnostic surveillance criteria had a sensitivity and specificity of 82.7 and 80.0% for probable CJD, respectively, and a positive predictive value of 80.5% for probable and 38.9% for 'possible' CJD. Alternative neuropathological diagnoses in suspect cases included Alzheimer's disease with or without Lewy body pathology, vascular encephalopathy, metabolic encephalopathies and viral or limbic encephalitis., Conclusion: The steady increase in mortality rates, especially in old age groups, most likely reflects improved case ascertainment due to active surveillance causing higher awareness of the medical community. In comparison with other European countries, it is reassuring to note that the overall death rate of TSEs does not differ from the Austrian autopsy-controlled data, thus confirming the value of clinical surveillance criteria., (Copyright 2008 S. Karger AG, Basel.)

Background: Primary angioplasty for acute myocardial infarction (AMI) can only be performed in a limited number of centers. Therefore, some patients will be referred for this procedure., Design: We analyzed the data of the prospective observational MITRA trial, which took place at 54 hospitals in southwest Germany, to describe current practices and outcomes in referred patients compared to patients treated on-site., Results: Out of 491 patients treated with primary angioplasty, 63 (12.8%) were referred. Out of 46 hospitals without facilities to perform primary angioplasty, 29 (63%) never referred patients. Referred patients were less often male (60.3% versus 75.9%; p = 0.013), suffered more often from anterior wall infarction (62.9% versus 45.8%; p = 0.014), and more often had absolute contraindications against thrombolysis (11.1% versus 2.8%; p = 0.006). In-hospital time to treatment was 80 minutes in patients treated on-site compared to 190 minutes in referred patients (p = 0.001). There was a non-significant difference of in-hospital mortality between the two groups (11.1% for referred versus 7.5% on-site; p = 0.319). Referred patients had a higher hospital morbidity as expressed by a higher proportion of post-infarction angina (28.6% versus 4.2%; p = 0.001), a more frequent need for urgent revascularization (43.8% versus 16.4%; p = 0.001) and a higher proportion of advanced heart failure (11.1% versus 4.4%; p = 0.062)., Conclusions: Referral of patients with AMI for primary angioplasty is used only in a minority of hospitals. The referred patients represent a selected, more ill subgroup, resulting in a higher hospital morbidity compared to patients treated on-site. Continuous efforts should be undertaken to decrease the time delay from admission at the initial hospital to the beginning of revascularization.