scholarly journals Early cardiac rehabilitation improved prognosis in patients with heart failure following acute myocardial infarction

2020 ◽  
Author(s):  
He Cai ◽  
Pengyu Cao ◽  
Wanqing Sun ◽  
Xinying Zhang ◽  
Rongyu Li ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Acute Myocardial Infarction ◽  
Risk Factor ◽  
Ejection Fraction ◽  
Cardiac Rehabilitation ◽  
Serum Potassium ◽  
Independent Risk Factor ◽  
Exercise Intolerance ◽  
Patients With Heart Failure

Abstract Background: Cardiac rehabilitation (CR) has been shown to improve exercise intolerance and QoL, and minimize re-hospitalizations in patients with congestive heart failure (CHF). However, studies on early CR in patients with acute myocardial infarction (AMI) who developed CHF following percutaneous coronary intervention (PCI) are rare. The purpose of this study is to evaluate the effectiveness of early CR on patients with CHF after AMI following PCI.Methods: Two hundred thirty-seven patients who developed heart failure after AMI following PCI were enrolled. Patients were divided into heart failure with reduced ejection fraction (HFrEF) group (n=55) and heart failure with mid-range ejection fraction (HFmrEF) group (n=182). Of the 237 patients, 78 (22 in HFrEF group and 56 in HFmrEF group) who accepted a two-week CR were further divided into two subgroups based on major adverse cardiovascular events (MACE). Key cardio-pulmonary exercise testing (CPX) variables that may affect the prognosis were identified among the CR patients.Results: Early CR significantly reduced cardiac death in patients with HFrEF (18.2% vs. 60.6%, P=0.02), and reduced re-hospitalization in patients with HFmrEF after AMI (3.6% vs. 21.4%, P=0.02). Serum potassium and CR ratio were independent risk factors for MACE in patients with both HFrEF and HFmrEF after AMI. In the CR group who developed MACE, there were more diabetics (22.2% vs. 66.7%, P=0.035), with higher serum potassium (3.96mmol/l vs. 4.31mmol/l, P=0.043), and lower PETCO2 at ventilatory threshold (VT) (P=0.016). PETCO2 at VT was an independent risk factor for re-hospitalization. The incidence of re-hospitalization was significantly lower when the PETCO2 at VT was greater than 33.5mmHg (0(0.00% vs. 6(13.64%), P=0.03).Conclusions: Early CR reduced the incidence of MACE in patients with heart failure after AMI following PCI. The PETCO2 at VT is an independent risk factor for re-hospitalization, and could be used as a key evaluating hallmark for early CR in patients who developed heart failure after AMI.

scholarly journals Early Cardiac Rehabilitation Improved Prognosis in Patients with Heart Failure Following Acute Myocardial Infarction

2020 ◽  
Author(s):  
He Cai ◽  
Pengyu Cao ◽  
Wanqing Sun ◽  
Xinying Zhang ◽  
Rongyu Li ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Acute Myocardial Infarction ◽  
Risk Factor ◽  
Ejection Fraction ◽  
Cardiac Rehabilitation ◽  
Serum Potassium ◽  
Independent Risk Factor ◽  
Exercise Intolerance ◽  
Patients With Heart Failure

Abstract Background: Cardiac rehabilitation (CR) has been shown to improve exercise intolerance and QoL, and minimize re-hospitalizations in patients with congestive heart failure (CHF). However, studies on early CR in patients with acute myocardial infarction (AMI) who developed CHF following percutaneous coronary intervention (PCI) are rare. The purpose of this study is to evaluate the effectiveness of early CR on patients with CHF after AMI following PCI.Methods: Two hundred thirty-seven patients who developed heart failure after AMI following PCI were enrolled. Patients were divided into heart failure with reduced ejection fraction (HFrEF) group and heart failure with mid-range ejection fraction (HFmrEF) group. Of which, 78 patients who accepted a two-week CR were further divided into two subgroups based on major adverse cardiovascular events (MACE). Key cardio-pulmonary exercise testing (CPX) variables that may affect the prognosis were identified through the comparison of the cardio-respiratory fitness (CRF).Results: Early CR significantly reduced cardiac death in patients with HFrEF, and reduced re-hospitalization in patients with HFmrEF after AMI (P <0.01). Serum potassium and CR ratio were independent risk factors for MACE in patients with both HFrEF and HFmrEF after AMI. In the CR group who developed MACE, there were more diabetics (P=0.035), with higher serum potassium (P=0.043), and lower PETCO2 at VT (P=0.016). PETCO2 at VT was an independent risk factor for re-hospitalization. The incidence of re-hospitalization was significantly lower when the PETCO2 at VT was greater than 33.5mmHg (P=0.03).Conclusions: Early CR reduced the incidence of MACE in patients with heart failure after AMI following PCI. The PETCO2 at VT is an independent risk factor for re-hospitalization, and could be used as a key evaluating hallmark for early CR in patients who developed heart failure after AMI.

scholarly journals Effect of early cardiac rehabilitation on prognosis in patients with heart failure following acute myocardial infarction

2021 ◽  
Vol 13 (1) ◽  
Author(s):  
He Cai ◽  
Pengyu Cao ◽  
Wenqian Zhou ◽  
Wanqing Sun ◽  
Xinying Zhang ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Acute Myocardial Infarction ◽  
Risk Factor ◽  
Ejection Fraction ◽  
Cardiac Rehabilitation ◽  
Anaerobic Threshold ◽  
Independent Risk Factor ◽  
Major Adverse Cardiovascular Events ◽  
Patients With Heart Failure

Abstract Objective The purpose of this retrospective study is to evaluate the effectiveness of early cardiac rehabilitation on patients with heart failure following acute myocardial infarction. Methods Two hundred and thirty-two patients who developed heart failure following acute myocardial infarction were enrolled in this study. Patients were divided into heart failure with reduced ejection fraction group (n = 54) and heart failure with mid-range ejection fraction group (n = 178). Seventy-eight patients who accepted a two-week cardiac rehabilitation were further divided into two subgroups based on major adverse cardiovascular events. Key cardio-pulmonary exercise testing indicators that may affect the prognosis were identified among the cardiac rehabilitation patients. Results Early cardiac rehabilitation significantly reduced cardiac death and re-hospitalization in patients. There was more incidence of diabetes, hyperkalemia and low PETCO2 in the cardiac rehabilitation group who developed re-hospitalization. Low PETCO2 at anaerobic threshold (≤ 33.5 mmHg) was an independent risk factor for re-hospitalization. Conclusions Early cardiac rehabilitation reduced major cardiac events in patients with heart failure following acute myocardial infarction. The lower PETCO2 at anaerobic threshold is an independent risk factor for re-hospitalization, and could be used as a evaluating hallmark for early cardiac rehabilitation.

Evaluation of acute myocardial infarction patients with mid-range ejection fraction after emergency percutaneous coronary intervention

2019 ◽  
Vol 95 (1125) ◽  
pp. 355-360
Author(s):  
Yufeng Jiang ◽  
Shengda Hu ◽  
Mingqiang Cao ◽  
Xiaobo Li ◽  
Jing Zhou ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Acute Myocardial Infarction ◽  
Ejection Fraction ◽  
Acute Heart Failure ◽  
Independent Risk Factor ◽  
Protective Factor ◽  
Coronary Intervention ◽  
Percutaneous Coronary ◽  
Emergency Percutaneous Coronary Intervention

BackgroundThere is currently no classification for acute myocardial infarction (AMI) according to left ventricular ejection fraction (LVEF). We aimed to perform a retrospective analysis of patients undergoing emergency percutaneous coronary intervention (PCI), comparing the clinical characteristics, in-hospital acute heart failure and all-cause death events of AMI patients with mid-range ejection fraction (mrEF), preserved ejection fraction (pEF) and reduced ejection fraction (rEF).Material and methodsTotally 1270 patients were stratified according to their LVEF immediately after emergency PCI into pEF group (LVEF 50% or higher), mrEF group (LVEF 40%–49%) and rEF group (LVEF <40%). Kaplan-Meier curves and log rank tests were used to assess the effects of mrEF, rEF and pEF on the occurrence of acute heart failure and all-cause death during hospitalisation. The Cox proportional hazards model was used for multivariate correction.ResultsCompared with mrEF, rEF was an independent risk factor for acute heart failure events during hospitalisation (HR 5.01, 95% CI 3.53 to 7.11, p<0.001), and it was also an independent risk factor for all-cause mortality during hospitalisation (HR 7.05, 95% CI 4.12 to 12.1, p<0.001); Compared with mrEF, pEF was an independent protective factor for acute heart failure during hospitalisation (HR 0.49, 95% CI 0.30 to 0.82, p=0.01), and it was also an independent protective factor for all-cause death during hospitalisation (HR 0.33, 95% CI 0.11 to 0.96, p=0.04).ConclusionsmrEF patients with AMI undergoing emergency PCI share many similarities with pEF patients in terms of clinical features, but the prognosis is significantly worse than that of pEF patients, suggesting that we need to pay attention to the management of mrEF patients with AMI.

scholarly journals Carvedilol versus metoprolol succinate in the treatment of patients with heart failure with reduced ejection fraction and patients with acute myocardial infarction

2021 ◽  
Vol 2021 (1) ◽  
pp. 36-39
Author(s):  
E.Ya. Nikolenko ◽  
◽  
K.V. Vovk ◽  
O.L. Pavlova ◽  
O.O. Salun ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Acute Myocardial Infarction ◽  
Ejection Fraction ◽  
Randomized Trials ◽  
Meta Analysis ◽  
Metoprolol Succinate ◽  
Reduced Ejection Fraction ◽  
Patients With Heart Failure ◽  
All Cause Mortality

Choosing the best drug for the treatment of cardiac patients remains one of the most important aspects of medical practice. The purpose of this review is to select the optimal beta-blocker for the treatment of patients with chronic heart failure and patients with acute myocardial infarction by comparing the efficacy of carvedilol and metoprolol succinate, as both drugs significantly reduce mortality rates and reduce hospitalization. The results of meta-analyzes, randomized trials comparing the efficacy of carvedilol and metoprolol succinate in the treatment of patients with heart failure with reduced ejection fraction and patients with acute myocardial infarction were analyzed. Conflicting data received. According to the study “Effect of carvedilol vs metoprolol succinate on mortality in heart failure with reduced ejection fraction”, a meta-analysis published in the American Journal of Cardiology in 2013, carvedilol is significantly more effective than metoprolol succinate in treatment of patients with heart failure with reduced ejection fraction and patients with acute myocardial infarction, while meta-analyzes of 2015 and 2017 showed no preference for carvedilol over metoprolol succinate. Based on the results, concluded that the data obtained is not sufficient to argue that carvedilol is more effective than metoprolol succinate for this category of patients in terms of reducing the risk of all-cause mortality, cardiovascular mortality, and reducing hospitalization. This problem requires further extensive research.

scholarly journals Ejection fraction, B-type natriuretic peptide and risk of stroke and acute myocardial infarction among patients with heart failure

2019 ◽  
Vol 42 (2) ◽  
pp. 277-284 ◽  
Author(s):  
Barry Greenberg ◽  
Eric D. Peterson ◽  
Jeffrey S. Berger ◽  
François Laliberté ◽  
Qi Zhao ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Acute Myocardial Infarction ◽  
Ejection Fraction ◽  
Natriuretic Peptide ◽  
Patients With Heart Failure

scholarly journals External Counterpulsation (ECP) Therapy as an Effective Treatment among Patients with Heart Failure undergoing Cardiac Rehabilitation

2018 ◽  
Vol 3 (1) ◽  
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Acute Myocardial Infarction ◽  
Pilot Study ◽  
Cardiac Rehabilitation ◽  
Exercise Capacity ◽  
Post Treatment ◽  
Combination Group ◽  
Patients With Heart Failure ◽  
Pre Treatment

Background: External counterpulsation (ECP) is a noninvasive procedure using lower limbs pressure cuffs to improve coronary artery blood flow and offload the heart. There is currently no data on the effects of ECP among patients undergoing cardiac rehabilitation (CR). This pilot study aims to determine whether ECP improves exercise capacity among patients with heart failure or post acute myocardial infarction undergoing cardiac rehabilitation. Methods: This is a prospective randomised-controlled pilot study of the effect of ECP in patients with mild to moderate heart failure or post-acute myocardial infarction undergoing CR. Eligible patients were randomised at ratio of 1:1 to either combination of CR and ECP or CR only. All subjects received up to 16 sessions of conventional CR. For the combination arm, subjects received up to 16 one-hour sessions of one-hour ECP therapy following each CR session. All underwent baseline cardiopulmonary testing (CPET) and NT-Pro BNP determination and after completion of study. Results: A total of 4 patients were enrolled in the study from June 2016 to Jan 2017. Two were randomised to combination arm and two into CR arm. Post treatment VO2MAX improved 12 % in the combination arm (23.3±5.6 ml/min/kg from20.8±5.3 ml/min/kgat baseline) compare to 5% in the CR arm (23.0±6.2 ml/min/kg from21.9±2.3 ml/min/kg at baseline). There were no significant difference in the post treatment VO2MAX between groups, p=0.97. There was a 16% increased in post treatment maximum oxygen pulsein the combination group (14.4±1.0ml/beat from12.4±0.5ml/beat at baseline) compare to a 7.8% increased in the CR group (12.4±2.2ml/beat from11.5±1.4ml/beat at baseline). Interestingly, NT proBNP level worsened post treatment in the combination group (447.5±563.6 pre treatment to 472.7±560.5 post treatment), whereas improved in the CR only group (950.5±522.9 pre treatment to 327.5±202.6 post treatment). Conclusion: Cardiac Rehabilitation is known to improve exercise capacity among heart failure patients. ECP can further enhanced maximum oxygen consumption and maximum oxygen pulse in patients with mild to moderate degree of heart failure or post myocardial infarction undergoing cardiac rehabilitation. More studies with larger numbers are needed to prove this benefit of ECP.

scholarly journals Multidisciplinary Cardiac Rehabilitation and Long-Term Prognosis in Patients With Heart Failure

2020 ◽  
Vol 13 (10) ◽  
Author(s):  
Kentaro Kamiya ◽  
Yukihito Sato ◽  
Tetsuya Takahashi ◽  
Miyuki Tsuchihashi-Makaya ◽  
Norihiko Kotooka ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Cardiac Rehabilitation ◽  
Preserved Ejection Fraction ◽  
Composite Outcome ◽  
Term Survival ◽  
Patients With Heart Failure ◽  
All Cause Mortality ◽  
Related Quality

Background: Exercise-based cardiac rehabilitation (CR) improves health-related quality of life and exercise capacity in patients with heart failure (HF). However, CR efficacy in patients with HF who are elderly, frail, or have HF with preserved ejection fraction remains unclear. We examined whether participation in multidisciplinary outpatient CR is associated with long-term survival and rehospitalization in patients with HF, with subgroup analysis by age, sex, comorbidities, frailty, and HF with preserved ejection fraction. Methods: This multicenter retrospective cohort study was performed in patients hospitalized for acute HF at 15 hospitals in Japan, 2007 to 2016. The primary outcome (composite of all-cause mortality and HF rehospitalization after discharge) and secondary outcomes (all-cause mortality and HF rehospitalization) were analyzed in outpatient CR program participants versus nonparticipants. Results: Of the 3277 patients, 26% (862) participated in outpatient CR. After propensity matching for potential confounders, 1592 patients were included (n=796 pairs), of which 511 had composite outcomes (223 [14%] all-cause deaths and 392 [25%] HF rehospitalizations, median 2.4-year follow-up). Hazard ratios associated with CR participation were 0.77 (95% CI, 0.65–0.92) for composite outcome, 0.67 (95% CI, 0.51–0.87) for all-cause mortality, and 0.82 (95% CI, 0.67–0.99) for HF-related rehospitalization. CR participation was also associated with numerically lower rates of composite outcome in patients with HF with preserved ejection fraction or frail patients. Conclusions: Outpatient CR participation was associated with substantial prognostic benefit in a large HF cohort regardless of age, sex, comorbidities, frailty, and HF with preserved ejection fraction.

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