Di seguito una selezione di contributi della letteratura corrente in tema di Cardiologia Riabilitativa pensata gentilmente per noi dal Prof. Tavazzi.
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1. Anker SD et al,
Exercise for frail, elderly patients with Acute Heart Failure – A strong step forward
NEJM 2021 385(3):276-277
- The results presented by Kitzman and colleagues provide a compelling argument for the adoption of exercise rehabilitation as standard care, even for elderly, frail patients with acute heart failure
- Bäck M et al,
The SWEDEHEART secondary prevention and cardiac rehabilitation registry (SWEDEHEART CR registry)
Eur Heart J Qual Care Clin Outcomes. 2021 Sep 16;7(5):431-437. doi: 10.1093/ehjqcco/qcab039.
- The SWEDEHEART-CR registry includes a high proportion of the national MI population entering a CR programme and is a powerful tool for quality audit, improvement, and research. The registry provides insights into the characteristics, treatment, and outcomes of evidence-based secondary preventive practice, ultimately leading to better cardiovascular health.
- Coats, AJS
Exergaming for heart failure: an idea so good it just ought to work
Eur J Heart Fail. 2021 Jan;23(1):125-126
Editorial comment
- As we have seen with the recent COVID-19 crisis, we need intervention that can be adhered to by patients, without the need for regular visits to hospital, and in this regard the work of Jaarsma and colleagues offers us some exciting possibilities to explore further, we just need to give non-pharmacological therapies the same chances as we do drug treatments, and that means more large-scale clinical trials.
- Docherty KF et al,
Eur J Heart Fail. 2021 Jan;23(1):136-139
Editorial comment
- A substantial body of evidence now exists supporting the clinical benefits in HFrEF of so-called ‘quadruple therapy’ with a combined neprilysin and angiotensin receptor inhibitor in addition to a beta-blocker, mineralocorticoid receptor antagonist and SGLT2 inhibitor along with device therapy, when indicated. As clinicians, we owe it to our patients to promote adoption of these therapies which improve symptoms, extend meaningful survival and prevent hospitalisation, even in the absence of evidence of benefit on endpoints such as those examined in OUTSTEP-HF.
- Elliott AD et al,
Eur Heart J. 2020 Apr 14;41(15):1479-1486. doi: 10.1093/eurheartj/ehz897.
PMID: 31951255 DOI: 10.1093/eurheartj/ehz897
- The risk of AF and ventricular arrhythmias is lower amongst physically active individuals. These findings provide observational support that physical activity is associated with reduced risk of atrial and ventricular arrhythmias.
- Ekblom Ö et al,
Eur J Prev Cardiol. 2021 Jun 7;zwab083
Research paper
- Participation in exCR was associated with reduced total mortality, and more pronounced in women, compared with men. Our results further support the recommendations to participate in exCR, and hence we argue that exCR should be a mandatory part of comprehensive CR programmes, offered to all patients post-MI.
- Hieda M et al,
Circulation. 2021 Sep 21;144(12):934-946
- In patients with LV hypertrophy and elevated cardiac biomarkers (stage B heart failure with preserved ejection fraction), 1 year of exercise training reduced LV myocardial stiffness. Thus, exercise training may provide protection against the future risk of heart failure with preserved ejection fraction in such patients. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT03476785.
- Holtermann A et al,
Eur Heart J. 2021 Apr 14;42(15):1499-1511
Clinical research
- Higher leisure time physical activity associates with reduced MACE and all-cause mortality risk, while higher occupational physical activity associates with increased risks, independent of each other.
- Kitzman DW et al,
Physical Rehabilitation for Older Patients Hospitalized for Heart Failure
N Engl J Med. 2021 Jul 15;385(3):203-216.
Randomized Controlled Trial
- In a diverse population of older patients who were hospitalized for acute decompensated heart failure, an early, transitional, tailored, progressive rehabilitation intervention that included multiple physical-function domains resulted in greater improvement in physical function than usual care. (Funded by the National Institutes of Health and others; REHAB-HF ClinicalTrials.gov number, NCT02196038.).
- Khoury M et al,
Circ Heart Fail. 2021 Sep 14;CIRCHEARTFAILURE121008738.
Conclusion: initiatives are warranted to promote and enable routine objective assessments of physical activity in youth with serious heart disease. Efforts such as these may facilitate shared decision-making between paediatric heart failure specialists and young patients and their families when discussing exercise practices in the context of promoting safe, beneficial physical activity
- Klompstra L et al,
Eur J Heart Fail. 2021 Jan;23(1):83-91; Position paper
- The choice of a monitor should depend on the research aims, study population and design regarding physical activity. If the aim is to motivate patients to be active or set goals, a less rigorously tested tool can be considered. On the other hand, if the aim is to measure physical activity and its changes over time or following treatment adjustment, it is important to choose a valid activity monitor with a storage and battery longevity of at least one week. The device should provide raw data and valid cut-off points should be chosen for analysing physical activity intensity levels. Other considerations in choosing an activity monitor should include data storage location and ownership and the upfront costs of the device.
- Mentz RJ, et al.
JACC Heart Fail 2021 Oct;9(10):747-757.
Conclusions: Among older patients hospitalized with ADHF, compared with HFrEF those with HFpEF had significantly worse impairments at baseline and may derive greater benefit from the intervention. (A Trial of Rehabilitation Therapy in Older Acute Heart Failure Patients [REHAB-HF]; NCT02196038).
- Pandey A et al,
JACC Heart Fail. 2021 Jul;9(7):471-481
- CR participation among eligible Medicare beneficiaries with HFrEF was low with minimal increase since 2014 Medicare coverage decision. Sex, race, and institution-dependent variables were independent predictors of CR participation.
- Pandey A et al,
Eur J Heart Fail. 2021 Sep;23(9):1552-1554. doi: 10.1002/ejhf.2313. Epub 2021 Aug 1.
- the PARALLAX trial has laid down the platform for conducting large, adequately powered trials evaluating exercise capacity and patient-centred outcomes in the contemporary HFpEF population. Its contribution to our understanding of HFpEF goes beyond the therapeutic effects of sacubitril/valsartan on the study endpoints. Future analyses from this trial will hopefully inform us about the determinants of the decline in exercise capacity and quality of life, and may help us find potentially modifiable targets to improve these patient-centred outcomes. Conflict of interest: A.P. has served on the advisory board of Roche Diagnostics, has received non-financial support from Pfizer and Merck, and has received research support from the Texas Health Resources Clinical Scholarship, the Gilead Sciences Research Scholar Program, the National Institute of Aging GEMSSTAR Grant (1R03AG067960-01), and Applied Thera-peutics. J.B. is a consultant to Abbott, Adrenomed, Amgen, Array, AstraZeneca, Bayer, Berlin Cures, Boehringer Ingelheim, Bristol-Myers Squib, CVRx, G3 Pharmaceutical, Impulse Dynamics, Innolife, Janssen, LivaNova, Luitpold, Medtronic, Merck, Novar-tis, Novo Nordisk, Relypsa, Roche, Sanofi, SC Pharma, V-Wave Limited, and Vifor
- Qiu S et al,
Eur Heart J Qual Care Clin Outcomes. 2021 Sep 16;7(5):496-504. doi: 10.1093/ehjqcco/qcaa051.
- LPA shows potential in reducing the risk of cardiovascular mortality, and interventions targeting at LPA improvement are worth being encouraged.
- Quindry JC et al,
Exercise Preconditioning as a Cardioprotective Phenotype
Am J Cardiol. 2021 Jun 1;148:8-15
- The prophylactic biochemical adaptations to aerobic exercise are complemented by the long-term adaptive benefits of vascular and architectural remodelling in those who adopt a physically active lifestyle.
- Rochester CL et al,
Pulmonary Rehabilitation in 2021
JAMA. 2021;326(10):969-970.
- PR is an essential treatment that improves patient-relevant outcomes, including exercise capacity, health-related QOL, dyspnea, fatigue, anxiety and depression, and, for COPD, possibly increased survival. PR should be considered as part of the integrated care of symptomatic patients with respiratory diseases. Increased access to PR could help benefit both patients and society by improving disease control and reducing symptom burden and health care utilization
- Rochester CL et al,
Pulmonary Rehabilitation and Improved Survival for Patients With COPD
JAMA. 2020;323(18):1783-1785. doi:10.1001/jama.2020.4436
Conclusion: It is time that one of the most effective treatments for patients with COPD and other chronic respiratory diseases be used routinely and proactively. In addition to improving exercise tolerance and quality of life and reducing symptoms, disease exacerbations, hospitalizations, and readmissions, participation in pulmonary rehabilitation after hospitalization for COPD exacerbation, as the article by Lindenauer et al. in this issue of JAMA suggests, is associated with lower all-cause mortality. These findings should serve to encourage health care systems to increase funding for, and use of, pulmonary rehabilitation services for patients with COPD
- Taylor RS, et al.
JACC Heart Fail 2021 Aug;9(8):608-609
- The COVID-19 pandemic has been a disruption to traditional health care models, and rapid implementation of home-based CR may be a favourable legacy of the pandemic. However, we must be careful to continue to evaluate the efficacy and safety of home-based CR to ensure that programs will improve patient quality of life and clinical outcomes.
- Wells A et al,
Circulation. 2021 Jul 6;144(1):23-33
- Group MCT+CR significantly improved depression and anxiety compared with usual care and led to greater reductions in unhelpful metacognitions and repetitive negative thinking. Most gains remained significant at 12 months. Study strengths include a large sample, a theory-based intervention, use of longer-term follow-up, broad inclusion criteria, and involvement of a trials unit. Limitations include no control for additional contact as part of MCT to estimate nonspecific effects, and the trial was not intended to assess cardiac outcomes. Nonetheless, results demonstrated that addition of the MCT intervention had broad and significant beneficial effects on mental health symptoms. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: ISRCTN74643496.
- Whellan DJ et al
JACC Heart Fail. 2021 Jul;9(7):482-483
- As with HF-ACTION, the design reflects the previous work of a number of investigators, so again form is following function. Time will tell if function will follow form.
- Baman JR et al,
JAMA. 2021 Jul 27;326(4):366.
- Some of the potential benefits of cardiac rehabilitation include decreased risk of death from a heart-related illness; decreased hospitalizations; decreased rates of depression; decreased symptoms such as anginal chest pain and fatigue; and improved physical conditioning, exercise tolerance, and quality of life.
- Brinkley TE et al,
Effects of Exercise and Weight Loss on Proximal Aortic Stiffness in Older Adults With Obesity
Circulation. 2021 Aug 31;144(9):684-693
- In older adults with obesity, combining aerobic exercise with moderate CR leads to greater improvements in proximal aortic stiffness than exercise alone. Registration: URL: https://clinicaltrials.gov; Unique identifier: NCT01048736.
- Brubaker PH et al,
JAMA. 2021 Aug 24;326(8):770.
Effect of Training on Peak Oxygen Consumption in Patients With Heart Failure With Preserved Ejection Fraction-Reply.
Mueller S, Haller B, Halle M; OptimEx-Clin Study Group.
JAMA. 2021 Aug 24;326(8):772-773. doi: 10.1001/jama.2021.10061.
PMID: 34427605.
- Buckley B et al,
JAMA. 2021 Aug 24;326(8):770-771
Effect of Training on Peak Oxygen Consumption in Patients With Heart Failure With Preserved Ejection Fraction-Reply.
Mueller S, Haller B, Halle M; OptimEx-Clin Study Group.
JAMA. 2021 Aug 24;326(8):772-773. doi: 10.1001/jama.2021.10061.
PMID: 34427605.
- Buckley B et al,
Eur J Prev Cardiol. 2021 Aug 1;zwab035
- Exercise-based CR was associated with lower odds of all-cause mortality, hospitalizations, incident stroke, and incident atrial fibrillation at 2-year follow-up for patients with HF (including patients with HFrEF and HFpEF).
- Costa EC et al,
JAMA. 2021 Aug 24;326(8):767-768.
Effect of Low-Intensity vs High-Intensity Walking Exercise on Walk Distance in Patients With Peripheral Artery Disease-Reply.
McDermott MM, Zhang D.
JAMA. 2021 Aug 24;326(8):769-770. doi: 10.1001/jama.2021.9768.
PMID: 34427606
- Dunlay SM et al,
Advanced Heart Failure Epidemiology and Outcomes: A Population-Based Study
JACC Heart Fail. 2021 Oct;9(10):722-732.
- In this population-based study, more than one-half of patients with advanced HF had mid-range or preserved EF, and survival was poor regardless of EF.
- Gurich L et al,
JAMA. 2021 Aug 24;326(8):767-768.
Effect of Low-Intensity vs High-Intensity Walking Exercise on Walk Distance in Patients With Peripheral Artery Disease-Reply.
McDermott MM, Zhang D.
JAMA. 2021 Aug 24;326(8):769-770. doi: 10.1001/jama.2021.9768.
PMID: 34427606
- Jankowski P et al,
Circ Cardiovasc Qual Outcomes. 2021 Aug;14(8):e007800.
- Managed care following myocardial infarction may be related to improved prognosis as it may facilitate access to cardiac rehabilitation and may provide a higher standard of outpatient cardiac care.
- Kini A et al,
Types of myocardial injury and mid-term outcomes in patients with COVID-19
Eur Heart J Qual Care Clin Outcomes. 2021 Sep 16;7(5):438-446.
- Chronic and acute myocardial injury represent two distinctive patterns of cardiac involvement among COVID-19 patients. While both types of myocardial injury are associated with impaired survival at 6 months, mortality rates peak in the early phase of the infection but remain elevated even beyond 30 days during the convalescent phase.
- McDermott MM et al,
JAMA. 2021 Aug 24;326(8):768-769.
- Mentz RJ et al,
JACC Heart Fail. 2021 Oct;9(10):747-757.
- Among older patients hospitalized with ADHF, compared with HFrEF those with HFpEF had significantly worse impairments at baseline and may derive greater benefit from the intervention. (A Trial of Rehabilitation Therapy in Older Acute Heart Failure Patients [REHAB-HF]; NCT02196038).
- Mueller S et al,
Effect of Training on Peak Oxygen Consumption in Patients With Heart Failure With Preserved Ejection Fraction-Reply.
Mueller S, Haller B, Halle M; OptimEx-Clin Study Group.
JAMA. 2021 Aug 24;326(8):772-773. doi: 10.1001/jama.2021.10061.
PMID: 34427605.
- Okamura M et al,
Effect of Training on Peak Oxygen Consumption in Patients With Heart Failure With Preserved Ejection Fraction-Reply.
Mueller S, Haller B, Halle M; OptimEx-Clin Study Group.
JAMA. 2021 Aug 24;326(8):772-773. doi: 10.1001/jama.2021.10061.
PMID: 34427605.
- Rahman A et al,
JAMA. 2021 Aug 24;326(8):767-768.
Effect of Low-Intensity vs High-Intensity Walking Exercise on Walk Distance in Patients With Peripheral Artery Disease-Reply.
McDermott MM, Zhang D.
JAMA. 2021 Aug 24;326(8):769-770. doi: 10.1001/jama.2021.9768.
PMID: 34427606
- Schulze AB et al,
Effect of Training on Peak Oxygen Consumption in Patients With Heart Failure With Preserved Ejection Fraction-Reply.
Mueller S, Haller B, Halle M; OptimEx-Clin Study Group.
JAMA. 2021 Aug 24;326(8):772-773. doi: 10.1001/jama.2021.10061.
PMID: 34427605.