The Role of Cardiac Rehabilitation in Reducing Major Adverse Cardiac Events in Heart Transplant Patients

Abstract Background Cardiovascular diseases are still the main cause of death in the western world. However, diminishing mortality rates of acute myocardial infarction (AMI) are motivating the need to investigate the process of stationary and ambulatory secondary prevention after AMI. Besides cardiac rehabilitation, disease management programs (DMPs) are an important component of outpatient care after AMI in Germany. This study aims to analyze outcomes after AMI among those who participated in DMPs and stationary cardiac rehabilitation (CR) in a region with overall increased cardiovascular morbidity and mortality. Methods: On the basis of data from a regional myocardial infarction registry and a 2-years follow up period, we assessed the occurrence of major adverse cardiac events (MACE) in relation to participation in CR and DMP, risk factors for complications and individual health, and lifestyle characteristics. Multivariable Cox regression was performed to compare survival time until an adverse event occurred.Results Out of 1,094 observed patients AMI, 272 were enrolled in a DMP. A weak association between DMP participation and hazard rates for MACE compared to non-enrollees was found in the crude model (hazard ratio = 0.93; 95% confidence interval = 0.65–1.33). When adjusted for possible confounders, this difference disappeared (1.03; 0.72–1.48). Furthermore, smokers and obese patients showed a distinctly lower chance of DMP enrollment. In contrast, participants of CR showed a lower risk for MACE in crude (0.52; 0.41–0.65) and adjusted analysis (0.56; 0.44–0.71).Conclusions Participation in DMP was not associated with a lower risk of MACE, while CR showed beneficial effects. Adjustment only slightly changed effect estimates in both cases, still potential effects of confounding need to be considered.

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Cardiac Rehabilitation Reduces the Rate of Major Adverse Cardiac Events after Percutaneous Coronary Intervention

European Journal of Cardiovascular Nursing ◽

10.1016/j.ejcnurse.2004.11.003 ◽

2005 ◽

Vol 4 (2) ◽

pp. 113-116 ◽

Cited By ~ 42

Author(s):

Paul Dendale ◽

Jan Berger ◽

Dominique Hansen ◽

Johan Vaes ◽

Edouard Benit ◽

...

Keyword(s):

Percutaneous Coronary Intervention ◽

Angina Pectoris ◽

Cardiac Rehabilitation ◽

Coronary Intervention ◽

Rehabilitation Program ◽

Major Adverse Cardiac Events ◽

Control Group ◽

Cardiac Events ◽

Adverse Cardiac Events ◽

Percutaneous Coronary

Background: Despite multiple publications on effects of rehabilitation in cardiac patients, rehabilitation is not fully known to be of value in post-percutaneous coronary intervention (PCI) patients. Aims: To investigate the influence of cardiac rehabilitation on the incidence of major adverse cardiac events (MACEs) in post-PCI patients. Methods: Retrospectively and nonrandomized 140 post-PCI patients (107 males, mean age 62 (7) years) participated in a 3-month rehabilitation program, starting 2 weeks post-PCI, while 83 post-PCI patients (54 males, mean age 68 (8) years) did not and were all followed up for 15 months. Data on cardiac medication prescription and incidence of MACE (including angina pectoris with or without reintervention, restenosis, myocardial infarction, revascularisation with re-PCI or CABG, and death) were collected. The relationship with cardiovascular risk factors including sex, smoking behaviour, obesity, diabetes mellitus, hypertension, familiar predisposition, and hypercholesterolemia was analysed. Results: The incidence of total MACE in the rehabilitation group is significantly lower than in the control group (24% vs. 42%, respectively; P<0.005). The incidence of documented restenosis, angina pectoris with resulting reintervention, all revascularisations, and death is significantly lower in the rehabilitation group, compared with the control group. Conclusion: The incidence of MACE and restenosis is significantly lower when PCI patients are included in a cardiac rehabilitation program.

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Comparing the Predictive Power of Preoperative Risk Assessment Tools to Best Predict Major Adverse Cardiac Events in Kidney Transplant Patients

Surgery Research and Practice ◽

10.1155/2019/9080856 ◽

2019 ◽

Vol 2019 ◽

pp. 1-6

Author(s):

Colin P. Dunn ◽

Emmanuel U. Emeasoba ◽

Ari J. Holtzman ◽

Michael Hung ◽

Joshua Kaminetsky ◽

...

Keyword(s):

Risk Assessment ◽

Assessment Tools ◽

Major Adverse Cardiac Events ◽

Receiver Operator Curve ◽

Cardiac Events ◽

Preoperative Risk ◽

Preoperative Risk Assessment ◽

Transplant Patients ◽

Adverse Cardiac Events ◽

Operator Curve

Background. Patients undergoing kidney transplantation have increased risk of adverse cardiovascular events due to histories of hypertension, end-stage renal disease, and dialysis. As such, they are especially in need of accurate preoperative risk assessment. Methods. We compared three different risk assessment models for their ability to predict major adverse cardiac events at 30 days and 1 year after transplant. These were the PORT model, the RCRI model, and the Gupta model. We used a method based on generalized U-statistics to determine statistically significant improvements in the area under the receiver operator curve (AUC), based on a common major adverse cardiac event (MACE) definition. For the top-performing model, we added new covariates into multivariable logistic regression in an attempt to create further improvement in the AUC. Results. The AUCs for MACE at 30 days and 1 year were 0.645 and 0.650 (PORT), 0.633 and 0.661 (RCRI), and finally 0.489 and 0.557 (Gupta), respectively. The PORT model performed significantly better than the Gupta model at 1 year (p=0.039). When the sensitivity was set to 95%, PORT had a significantly higher specificity of 0.227 compared to RCRI’s 0.071 (p=0.009) and Gupta’s 0.08 (p=0.017). Our additional covariates increased the receiver operator curve from 0.664 to 0.703, but this did not reach statistical significance (p=0.278). Conclusions. Of the three calculators, PORT performed best when the sensitivity was set at a clinically relevant level. This is likely due to the unique variables the PORT model uses, which are specific to transplant patients.

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Participation in disease management programs and major adverse cardiac events in patients after acute myocardial infarction. A longitudinal study based on registry data

10.21203/rs.3.rs-25395/v3 ◽

2020 ◽

Author(s):

Christian Fischer ◽

Jens Höpner ◽

Saskia Hartwig ◽

Michel Noutsias ◽

Rafael Mikolajczyk

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Disease Management ◽

Cardiac Rehabilitation ◽

Lower Risk ◽

Major Adverse Cardiac Events ◽

Cardiac Events ◽

Disease Management Programs ◽

Confounding Variables ◽

Adverse Cardiac Events

Abstract Background: Cardiovascular diseases are still the main cause of death in the western world. However, diminishing mortality rates of acute myocardial infarction (AMI) are motivating the need to investigate the process of secondary prevention after AMI. Besides cardiac rehabilitation, disease management programs (DMPs) are an important component of outpatient care after AMI in Germany. This study aims to analyze outcomes after AMI among those who participated in DMPs and cardiac rehabilitation (CR) in a region with overall increased cardiovascular morbidity and mortality. Methods: Based on data from a regional myocardial infarction registry and a 2-year follow-up period, we assessed the occurrence of major adverse cardiac events (MACE) in relation to participation in CR and DMP, risk factors for complications and individual healthas well as lifestyle characteristics. Multivariable Cox regression was performed to compare survival time between participants and non-participants until an adverse event occurred. Results: Of 1,094 observed patients post-AMI, 272 were enrolled in a DMP. An association between DMP participation and lower hazard rates for MACE compared to non-enrollees could not be proven in the crude model (hazard ratio = 0.93; 95% confidence interval = 0.65-1.33). When adjusted for possible confounding variables, these results remained virtually unchanged (1.03; 0.72-1.48). Furthermore, smokers and obese patients showed a distinctly lower chance of DMP enrollment. In contrast, those who participated in CR showed a lower risk for MACE in crude (0.52; 0.41-0.65) and adjusted analysis (0.56; 0.44-0.71). Conclusions: Participation in DMP was not associated with a lower risk of MACE, but participation in CR showed beneficial effects. Adjustment only slightly changed effect estimates in both cases, but it is still important to consider potential effects of confounding variables.

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The impact of the coronary collateral circulation on outcomes in patients with acute coronary syndromes: results from the ACUITY trial

Heart ◽

10.1136/heartjnl-2013-304435 ◽

2013 ◽

Vol 100 (8) ◽

pp. 647-651 ◽

Cited By ~ 12

Author(s):

Pascal Meier ◽

Alexandra J Lansky ◽

Martin Fahy ◽

Ke Xu ◽

Harvey D White ◽

...

Keyword(s):

Clinical Outcomes ◽

Collateral Circulation ◽

Major Adverse Cardiac Events ◽

Cardiac Events ◽

Coronary Collateral Circulation ◽

Coronary Syndrome ◽

Coronary Collateral ◽

Adverse Cardiac Events ◽

The Impact

ObjectiveWe sought to assess the prognostic role of collaterals in a large population of patients presenting with an acute coronary syndrome (ACS).MethodsThe coronary collateral circulation was assessed by an independent angiographic core laboratory using the Rentrop Score in patients enrolled in the randomised Acute Catheterization and Urgent Intervention Triage Strategy trial.ResultsThe cohort comprised 5412 patients with moderate to high risk ACS. A total of 858 patients (16.0%) had visible collaterals while 4554 patients (84.0%) had no collaterals. After multivariable adjustment, there were no differences in clinical outcomes at 1 year between the groups, including major adverse cardiac events (MACE) (HR 0.94 (95% CI 0.76 to 1.16), p=0.55), mortality (HR 1.03 (0.65 to 1.62), p=0.91), myocardial infarction (MI) (HR 1.07 (0.83 to 1.38), p=0.60) and unplanned target vessel revascularisation (TVR) (HR 0.95 (0.71 to 1.28), p=0.75). Similarly, in the subgroup of patients undergoing percutaneous coronary intervention (PCI), the adjusted HR for major adverse cardiac events was 1.1 (0.76 to 1.61), p=0.595; 0.81 (0.10 to 6.44), p=0.999 for mortality; and 0.86 (0.54 to 1.35), p=0.564 for MI. The risk of unplanned TVR was increased (HR 2.74 (1.48 to 5.10), p=0.004).ConclusionsIn contrast to other studies, this large core laboratory-based analysis does not confirm a beneficial role of visible coronary collateral vessels on clinical outcomes in patients with ACS; the presence of collaterals was even associated with increased mortality in the unadjusted analysis. Collaterals were associated with a higher risk of TVR in patients undergoing PCI, a finding that may not have been fully corrected given confounders and clinical differences between the groups.Trial registrationClinicalTrials.gov Identifier: NCT00093158.

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Coronary Flow Reserve Predicts Major Adverse Cardiac Events and All-Cause Mortality in Heart Transplant Recipients

The Journal of Heart and Lung Transplantation ◽

10.1016/j.healun.2021.01.402 ◽

2021 ◽

Vol 40 (4) ◽

pp. S128-S129

Author(s):

K.P. Bjerre ◽

T. Clemmensen ◽

S. Poulsen ◽

A. Hvas ◽

B. Løgstrup ◽

...

Keyword(s):

Coronary Flow Reserve ◽

Heart Transplant ◽

Coronary Flow ◽

Major Adverse Cardiac Events ◽

Transplant Recipients ◽

Cardiac Events ◽

Flow Reserve ◽

Adverse Cardiac Events ◽

All Cause Mortality ◽

Heart Transplant Recipients

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Participation in disease management programs and major adverse cardiac events in patients after acute myocardial infarction. A longitudinal study based on registry data.

10.21203/rs.3.rs-25395/v2 ◽

2020 ◽

Author(s):

Christian Fischer ◽

Jens Höpner ◽

Saskia Hartwig ◽

Michel Noutsias ◽

Rafael Mikolajczyk

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Disease Management ◽

Cardiac Rehabilitation ◽

Lower Risk ◽

Major Adverse Cardiac Events ◽

Cardiac Events ◽

Disease Management Programs ◽

Confounding Variables ◽

Adverse Cardiac Events

Abstract Background: Cardiovascular diseases are still the main cause of death in the western world. However, diminishing mortality rates of acute myocardial infarction (AMI) are motivating the need to investigate the process of secondary prevention after AMI. Besides cardiac rehabilitation, disease management programs (DMPs) are an important component of outpatient care after AMI in Germany. This study aims to analyze outcomes after AMI among those who participated in DMPs and cardiac rehabilitation (CR) in a region with overall increased cardiovascular morbidity and mortality. Methods: Based on data from a regional myocardial infarction registry and a 2-year follow-up period, we assessed the occurrence of major adverse cardiac events (MACE) in relation to participation in CR and DMP, risk factors for complications and individual healthas well as lifestyle characteristics. Multivariable Cox regression was performed to compare survival time between participants and non-participants until an adverse event occurred. Results: Of 1,094 observed patients post-AMI, 272 were enrolled in a DMP. An association between DMP participation and lower hazard rates for MACE compared to non-enrollees could not be proven in the crude model (hazard ratio = 0.93; 95% confidence interval = 0.65-1.33). When adjusted for possible confounding variables, these results remained virtually unchanged (1.03; 0.72-1.48). Furthermore, smokers and obese patients showed a distinctly lower chance of DMP enrollment. In contrast, those who participated in CR showed a lower risk for MACE in crude (0.52; 0.41-0.65) and adjusted analysis (0.56; 0.44-0.71). Conclusions: Participation in DMP was not associated with a lower risk of MACE, but participation in CR showed beneficial effects. Adjustment only slightly changed effect estimates in both cases, but it is still important to consider potential effects of confounding variables.

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