Impact of and Reasons for Not Performing Exercise Training After an Acute Coronary Syndrome in the Setting of an Interdisciplinary Cardiac Rehabilitation Program: Results From a Risk-Op- Acute Coronary Syndrome Ambispective Registry

Background and Aims: Exercise training (ET) is a critical component of cardiac rehabilitation (CR), but it remains underused. The aim of this study was to compare clinical outcomes between patients who completed ET (A-T), those who accepted ET but did not complete it (A-NT), and those who did not accept to undergo it (R-NT), and to analyze reasons for rejecting or not completing ET.Methods and Results: A unicenter ambispective observational registry study of 497 patients with acute coronary syndrome (ACS) was carried out in Barcelona, Spain, from 2016 to 2019. The primary endpoint was a composite of all-cause mortality, hospitalization for ACS, or need for revascularization during follow-up. Multivariable analysis was carried out to identify variables independently associated with the primary outcome. Initially, 70% of patients accepted participating in the ET, but only 50.5% completed it. The A-T group were younger and had fewer comorbidities. Baseline characteristics in A-NT and R-NT groups were very similar. The main reason for not undergoing or completing ET was rejection (reason unknown) or work/schedule incompatibility. The median follow-up period was 31 months. Both the composite primary endpoint and mortality were significantly lower in the A-T group compared to the A-NT and R-NT (primary endpoint: 3.6% vs. 23.2% vs. 20.4%, p < 0.001, respectively; mortality: 0.8% vs. 9.1% vs. 8.2%, p < 0.001; respectively). During multivariable analysis, the only variables that remained statistically significant with the composite endpoint were ET completion, previous ACS, and anemia.Conclusion: Completion of ET after ACS was associated with improved prognosis. Only half of the patients completed the ET program, with the leading reasons for not completing it being refusal (reason unknown) and work/schedule incompatibility. These results highlight the need to focus on the needs of patients in order to guarantee that structural barriers to ET no longer exist.

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Relationships between Psychoeducational Rehabilitation and Health Outcomes—A Systematic Review Focused on Acute Coronary Syndrome

Journal of Personalized Medicine ◽

10.3390/jpm11060440 ◽

2021 ◽

Vol 11 (6) ◽

pp. 440

Author(s):

Sabina Alexandra Cojocariu ◽

Alexandra Maștaleru ◽

Radu Andy Sascău ◽

Cristian Stătescu ◽

Florin Mitu ◽

...

Keyword(s):

Acute Coronary Syndrome ◽

Cardiac Rehabilitation ◽

Psychological Intervention ◽

Nyha Class ◽

Illness Perception ◽

Rehabilitation Program ◽

Psychoeducational Intervention ◽

Current Evidence ◽

Major Adverse Cardiovascular Events ◽

Coronary Syndrome

(1) Background: Cardiac rehabilitation is a multidisciplinary program that includes psychoeducational support in addition to physical exercise. Psychoeducational intervention is a component that has had accelerated interest and development in recent decades. The aim was to analyze the current evidence on the effectiveness of psychoeducational interventions for patients with acute coronary syndrome (ACS). (2) Methods: We conducted a systematic search of the literature via four databases: PubMed, CENTRAL, PsycINFO, and EMBASE. We included randomized controlled trials that evaluated the effectiveness of a psychoeducational intervention compared to usual care in ACS patients. We assessed the risk of bias using a modified version of the Cochrane tool. We analyzed data regarding the population, intervention, comparator, outcomes, and timing. (3) Results: We identified 6248 studies. After a rigorous screening, we included in the analysis 11 articles with a total of 3090 participants. Major adverse cardiovascular events, quality of life, hospitalizations, lipidogram, creatinine, NYHA class, smoking, physical behavior, and emotional state were significantly improved. In addition, illness perception, knowledge, and beliefs were substantially ameliorated (all p < 0.001). All this was related to the type and dose of psychological intervention. (4) Conclusions: Patients with ACS can receive significant benefits through individualized psychoeducation sessions. The cardiac rehabilitation program should include personalized psychological and educational intervention by type and dose.

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Impact of cardiac rehabilitation on 3 year outcomes amongst patients after acute coronary syndrome: (ACS) SNAPSHOT ACS follow-up study

European Heart Journal ◽

10.1093/ehjci/ehaa946.3108 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

J Redfern ◽

K Hyun ◽

D Brieger ◽

D Chew ◽

J French ◽

...

Keyword(s):

Acute Coronary Syndrome ◽

Cardiac Rehabilitation ◽

Data Linkage ◽

Research Network ◽

Funding Source ◽

Cardiovascular Research ◽

Coronary Syndrome ◽

Follow Up Study ◽

Significant Difference

Abstract Background Cardiovascular disease is the leading cause of disease burden globally. With advancements in medical and surgical care more people are surviving initial acute coronary syndrome (ACS) and are in need of secondary prevention and cardiac rehabilitation (CR). Increasing availability of high quality individual-level data linkage provides robust estimates of outcomes long-term. Purpose To compare 3 year outcomes amongst ACS survivors who did and did not participate in Australian CR programs. Methods SNAPSHOT ACS follow-up study included 1806 patients admitted to 232 hospitals who were followed-up by data linkage (cross-jurisdictional morbidity, national death index, Pharmaceutical Benefit Schedule) at 6 and 36 months to compare those who did/not attend CR. Results In total, the cohort had a mean age of 65.8 (13.4) years, 60% were male, only 25% (461/1806) attended CR. During index admission, attendees were more likely to have had PCI (39% v 14%, p<0.001), CABG (11% v 2%, p<0.001) and a diagnosis of STEMI (21% v 5%, p<0.001) than those who did not attend. However, there was no significant difference between CR attendees/non-attendees for risk factors (LDL-cholesterol, smoking, obesity). Only 19% of eligible women attended CR compared to 30% of men (p<0.001). At 36 months, there were fewer deaths amongst CR attendees (19/461, 4.1%) than non-attendees (116/1345, 8.6%) (p=0.001). CR attendees were more likely to have repeat ACS, PCI, CABG at both 6 and 36 months (Table). At 36 months, CR attendees were more likely to have been prescribed antiplatelets (78% v 53%, p<0.001), statins (91% 73%, p<0.001), beta-blockers (11% v 13%, p=0.002) and ACEI/ARBs (72% v 61%, p<0.001) than non-attendees. Conclusions Amongst Australian ACS survivors, participation in CR was associated with less likelihood of death and increased prescription of pharmacotherapy. However, attendance at CR was associated with higher rates of repeat ACS and revascularisation. Funding Acknowledgement Type of funding source: Foundation. Main funding source(s): New South Wales Cardiovascular Research Network, National Heart Foundation

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Cardiac rehabilitation program after an acute coronary syndrome in the elderly population: benefits and safety

European Heart Journal ◽

10.1093/eurheartj/eht310.p5806 ◽

2013 ◽

Vol 34 (suppl 1) ◽

pp. P5806-P5806

Author(s):

D. Gemma ◽

S. O. Rosillo Rodriguez ◽

F. De Torres Alba ◽

S. Del Prado Diaz ◽

A. M. Iniesta Manjavacas ◽

...

Keyword(s):

Acute Coronary Syndrome ◽

Cardiac Rehabilitation ◽

Elderly Population ◽

The Elderly ◽

Rehabilitation Program ◽

Cardiac Rehabilitation Program ◽

Coronary Syndrome

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Cardiorehabilitation of Patients with Acute Coronary Syndrome Who Were Performed Coronary Arteries Revascularization

Galician Medical Journal ◽

10.21802/gmj.2017.4.9 ◽

2017 ◽

Vol 24 (4) ◽

Author(s):

Mykola Shved ◽

Lesja Tsuglevych ◽

Iryna Kyrychok ◽

Tetiana Boiko ◽

Larysa Levutska

Keyword(s):

Heart Rate ◽

Heart Rate Variability ◽

Acute Coronary Syndrome ◽

Coronary Artery ◽

Cardiac Rehabilitation ◽

Rehabilitation Program ◽

Left Ventricular ◽

Cardiac Rehabilitation Program ◽

Coronary Artery Revascularization ◽

Coronary Syndrome

In patients with acute coronary syndrome who were performed coronary arteries’ revascularization, in the postoperative period disorders of hemodynamics and heart rate variability often develop. The aim of our work was to optimize the cardiac rehabilitation of such patients by individualization of physical activity depending on the state of systolic and diastolic left ventricular dysfunction and heart rate variability. 40 patients with acute coronary syndrome and coronary artery revascularization were included into the experimental group. The control group consisted of 20 patients of the same age, clinical and laboratory manifestations of ACS who were treated according to the protocol of Ministry of Health of Ukraine. In both groups of patients clinical efficacy of cardiac rehabilitation process was evaluated according to the dynamics of clinical symptoms, systolic and diastolic left ventricular function and heart rate variability. In patients with acute coronary syndrome and coronary artery revascularization in the initial state the clinical and laboratory signs of myocardial ischemia disappear, but subclinical and clinical manifestations of heart failure remain. During the first month of training, the original accelerated cardiac rehabilitation program leads to the decrease of systolic and diastolic signs of cardiac dysfunction and improves heart rate variability, which significantly improves the quality of life of these patients. For monitoring the efficacy and safety of the performance of cardiac rehabilitation program in patients with acute coronary syndrome and coronary artery revascularization, in addition to conventional methods (determination of heart rate, blood pressure, 6-minute test), it is useful to diagnose subclinical stage of heart failure by examination of systolic, diastolic function and vegetative regulation.

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Do Patients Maintain Proper Long-Term Cardiopulmonary Fitness Levels After Cardiac Rehabilitation? A Retrospective Study Using Medical Records

Annals of Rehabilitation Medicine ◽

10.5535/arm.20123 ◽

2021 ◽

Vol 45 (2) ◽

pp. 150-159

Author(s):

Chul Kim ◽

Hee Eun Choi ◽

Jin Hyuk Jang ◽

Jun Hyeong Song ◽

Byung-Ok Kim

Keyword(s):

Retrospective Study ◽

Exercise Training ◽

Cardiac Rehabilitation ◽

Artery Bypass ◽

Bypass Graft ◽

Hospital Setting ◽

Aerobic Exercise Training ◽

Cardiopulmonary Fitness ◽

Coronary Syndrome

Objective To examine whether patients who participated in a cardiac rehabilitation (CR) program after hospitalization for acute coronary syndrome maintained cardiorespiratory fitness (CRF) in the community.Methods We conducted a retrospective study including 78 patients who underwent percutaneous coronary intervention or coronary artery bypass graft surgery at our hospital’s cardiovascular center and participated in a CR program and a 5-year follow-up evaluation. Patients were divided into a center-based CR (CBCR) group, participating in an electrocardiography-monitored exercise training in a hospital setting, and a home-based CR (HBCR) group, receiving aerobic exercise training and performed self-exercise at home.Results No significant differences were found between groups (p>0.05), except the proportion of non-smokers (CBCR 59.5% vs. HBCR 31.7%; p=0.01). In both groups, the maximal oxygen consumption (VO2max) increased significantly during the first 12 weeks of follow-up and remained at a steady state for the first year, but it decreased after the 1-year follow-up. Particularly, VO2max at 5 years decreased below the baseline value in the HBCR group. In the low CRF group, the CRF level significantly improved at 12 weeks, peaked at 1 year, and was still significantly different from the baseline value after 5 years. The high CRF group did not show any significant increase over time relative to the baseline value, but most patients in the high CRF group maintained relatively appropriate CRF levels after 5 years.Conclusion Continuous support should be provided to patients to maintain optimal CRF levels after completing a CR program.

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Gender differences in risk profile and response to a cardiac rehabilitation program after an acute coronary syndrome

European Heart Journal ◽

10.1093/eurheartj/eht310.p5802 ◽

2013 ◽

Vol 34 (suppl 1) ◽

pp. P5802-P5802

Author(s):

F. De Torres Alba ◽

S. Rosillo Rodriguez ◽

D. Gemma ◽

A. Iniesta Manjavacas ◽

S. Valbuena Lopez ◽

...

Keyword(s):

Gender Differences ◽

Acute Coronary Syndrome ◽

Cardiac Rehabilitation ◽

Rehabilitation Program ◽

Risk Profile ◽

Cardiac Rehabilitation Program ◽

Coronary Syndrome

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The Effect of Atrial Fibrillation on the Long-Term Mortality of Patients with Acute Coronary Syndrome: The TACOS Study

Cardiology ◽

10.1159/000516369 ◽

2021 ◽

pp. 1-9

Author(s):

Kaari K. Konttila ◽

Olli Punkka ◽

Kimmo Koivula ◽

Markku J. Eskola ◽

Mika Martiskainen ◽

...

Keyword(s):

Atrial Fibrillation ◽

Acute Coronary Syndrome ◽

Hospital Admission ◽

Atrial Flutter ◽

Multivariable Analysis ◽

Sinus Arrhythmia ◽

Long Term Outcome ◽

Coronary Syndrome

Introduction: Atrial fibrillation (AF) is a frequent finding in acute coronary syndrome (ACS), but there is conflicting scientific evidence regarding its long-term impact on patient outcome. The aim of this study was to survey and compare the ≥10-year mortality of ACS patients with sinus rhythm (SR) and AF. Methods: Patients were divided into 2 groups based on rhythm in their 12-lead ECGs: (1) SR (n = 788) at hospital admission and discharge (including sinus bradycardia, physiological sinus arrhythmia, and sinus tachycardia) and (2) AF/atrial flutter (n = 245) at both hospital admission and discharge, or SR and AF combination. Patients who failed to match the inclusion criteria were excluded from the final analysis. The main outcome surveyed was long-term all-cause mortality between AF and SR groups during the whole follow-up time. Results: Consecutive ACS patients (n = 1,188, median age 73 years, male/female 58/42%) were included and followed up for ≥10 years. AF patients were older (median age 77 vs. 71 years, p < 0.001) and more often female than SR patients. AF patients more often presented with non-ST-elevation myocardial infarction (69.8 vs. 50.4%, p < 0.001), had a higher rate of diabetes (31.0 vs. 22.8%, p = 0.009), and were more often using warfarin (32.2 vs. 5.1%, p < 0.001) or diuretic medication (55.1 vs. 25.8%, p < 0.001) on admission than patients with SR. The use of warfarin at discharge was also more frequent in the AF group (55.5 vs. 14.8%, p < 0.001). The rates of all-cause and cardiovascular mortality were higher in the AF group (80.9 vs. 50.3%, p < 0.001, and 73.8 vs. 69.6%, p = 0.285, respectively). In multivariable analysis, AF was independently associated with higher mortality when compared to SR (adjusted HR 1.662; 95% CI: 1.387–1.992, p < 0.001). Conclusion: AF/atrial flutter at admission and/or discharge independently predicted poorer long-term outcome in ACS patients, with 66% higher mortality within the ≥10-year follow-up time when compared to patients with SR.

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Impact of an online cardiac rehabilitation program after an acute coronary syndrome during SARS-CoV-2 pandemic

European Journal of Preventive Cardiology ◽

10.1093/eurjpc/zwab061.331 ◽

2021 ◽

Vol 28 (Supplement_1) ◽

Author(s):

A Severo Sanchez ◽

B Rivero Santana ◽

E Arbas Redondo ◽

VM Juarez Olmos ◽

D Poveda Pinedo ◽

...

Keyword(s):

Health Care ◽

Acute Coronary Syndrome ◽

Cardiac Rehabilitation ◽

Mediterranean Diet ◽

Cardiovascular Health ◽

New Technologies ◽

Rehabilitation Program ◽

Prevention Measures ◽

Coronary Syndrome ◽

The Impact

Abstract Funding Acknowledgements Type of funding sources: Public hospital(s). Main funding source(s): Hospital Universitario La Paz Introduction The SARS-CoV-2 pandemic has overloaded health care systems at several fields. Spanish COVID-19 first wave led to the interruption of most cardiac rehabilitation (CRH) programs in our country. Resume activity without compromising patient"s safety has been a challenge. At our centre (a third-level hospital), we modified our routine clinical practice from face-to-face interviews to a complete online CRH program since July 1st 2020. Purpose The aim of this study is to analyse the impact of an online CRH program after hospital discharge for an acute coronary syndrome in health goals and adherence to secondary prevention measures at the end of the program. Methods This is a retrospective study made up of patients who, after suffering an acute myocardial infarction, followed an online CRH program from June to November 2020. A first online assessment is made by a cardiology consultant. Then, it is followed by ten online group interviews of up to three patients and a health care proffesional: either a nurse or a physiotherapist. These interviews last around ninety minutes. Four weeks after, an online follow-up interview is made by a cardiology consultant. These interviews focus either on physical exercise instructions (aerobical exercise and endurance exercise) or educational interviews (ischemic cardiomyopathy, Mediterranean diet, pharmacological treatment, sexual dysfunction, stress management techniques and solution of questions). Results Up to eighty-four patients were included in our CRH program (this means 83% of patients discharged from our hospital after an acute coronary event). Median of time from discharge to first online interview was 8"79 days and from this last one to program beginning, 3"67 days. Four weeks after the beginning of the program, 82% of the patients presented with a LDL-cholesterol level below aim level (< 55 mg/dL). Workout, Mediterranean diet and tobacco abstinence observance rates were over 90%. There were just three patients who gave up or did not complete the program. Conclusion Despite the fact that SARS-CoV-2 pandemic has arisen a huge challenge for ongoing CRH programs in Spain, the benefit that has been showed by them on cardiovascular health, makes it necessary to develop new tools to allow them going on. New technologies are an opportunity for us to keep on following these patients, moreover showing good results as for adherence, availability and patient and operator assesssment.

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P6442The acute on chronic glycaemic ratio: a simple tool to stratify risk in acute coronary syndrome patients

European Heart Journal ◽

10.1093/eurheartj/ehz746.1036 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

J Alves Guimaraes ◽

F M Goncalves ◽

S Borges ◽

J J Monteiro ◽

P S Mateus ◽

...

Keyword(s):

Acute Coronary Syndrome ◽

Primary Endpoint ◽

Youden Index ◽

Admission Diagnosis ◽

Severe Illness ◽

Hospital Death ◽

Prognostic Information ◽

Risk Of Death ◽

Coronary Syndrome

Abstract Background Stress hyperglycaemia (SH) is a transient elevation of blood glucose (Gc) associated with acute, severe illness. However, the presence of hyperglycemia does not necessarily indicate the presence of SH, thus, the relative acute Gc rise provided by the ratio between acute and chronic Gc levels (A/C ratio) could more accurately represent so. Objective We investigated the association between the A/C ratio with in-hospital and long term prognosis in Acute Coronary Syndrome (ACS) patients. Methods Retrospective study of patients with ACS included in a single center between Jan/2012 and Dec/2017. Gc and HbA1c levels were measured at hospital admission. To calculate the A/C ratio the published formula 28.7×HbA1c-46.7 to estimate chronic Gc was used. The primary endpoints were a composite of in-hospital death and Killip class (KK) ≥III and a composite of infarction, stroke, heart failure and cardiovascular death (MACCE) in the follow-up. Results We included 404 patients (68±13 years; 72.8% males; 43.6% STEMI). The median A/C ratio was 1.07 (IQR 0.92–1.32). Patients in the highest tertile of the A/C ratio had a higher GRACE risk score (134±32, 139±38, 158±42; p<0.001); higher KK (≥II: 11%, 24%, 33%; p<0.001) and a lower ejection fraction (EF) (53±10%, 50±10%, 48±12%; p=0.003), than patients in the lower tertiles. During hospitalization 9 (2.2%) patientss died and 48 (11.9%) had the primary endpoint. The incidence of the in-hospital primary endpoint increased with A/C ratio tertiles (4.4%, 8.2%, 23.0%; p for trend <.001), for which it showed a good predictive capability (AUC=0.72, 95% CI: 0.67–0.76). Using the Youden index the cut-off value of 1.31 for the A/C ratio was decided. After a median follow-up of 34 months (IQR 19–51), 50 (13%) patients died and 84 (21.9%) had MACCE. After adjusting for admission diagnosis, diabetes mellitus, GRACE and EF, an A/C ratio>1.31 was an independent predictor for the risk of death (HR 2.79, 95% CI: 1.17–6.65; p=0.021) and MACCE (HR 1.79, 95% CI: 1.09–2.93; p=0.020) in the follow-up. Conclusion In ACS patients, the A/C glycemic ratio increased with the severity of the index event and was a predictor of death and MACCE during the follow-up. It is readily available and provides valuable risk stratification and prognostic information.

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P824The clinical impact of polyunsaturated fatty acid on clinical outcomes in acute coronary syndrome with dyslipidemia: HIJ-PROPER sub-analysis

European Heart Journal ◽

10.1093/eurheartj/ehz747.0423 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

M Nakawaza ◽

H Arashi ◽

H Nomura ◽

E Kawada-Watanabe ◽

M Ogiso ◽

...

Keyword(s):

Acute Coronary Syndrome ◽

Arachidonic Acid ◽

Eicosapentaenoic Acid ◽

Clinical Outcomes ◽

Primary Endpoint ◽

Lipid Lowering ◽

Lipid Lowering Therapy ◽

Coronary Syndrome ◽

Lowering Therapy

Abstract Background Polyunsaturated fatty acids, especially omega-3 and -6 series, are key essential nutrients that play an important role in humans to maintain cell membranes and function. A recent randomized trial reported that adding eicosapentaenoic acid (EPA) to statins was beneficial to cardiovascular disease patients who had a residual risk factor. Further, several studies have reported that the low baseline value for EPA to arachidonic acid (AA) ratio is related to worse clinical outcome and plaque vulnerability in coronary artery disease patients. However, effects of baseline EPA/AA ratio on clinical outcomes in ACS patients have not been thoroughly evaluated. Objectives This study aimed to examine the impact of baseline eicosapentaenoic acid to arachidonic acid (EPA/AA) ratio on clinical outcomes of acute coronary syndrome (ACS) patients and how lipid-lowering therapy affects serum EPA/AA levels in these patients. Methods This is a sub-analysis of HIJ-PROPER assessing the effect of aggressive low-density lipoprotein cholesterol (LDL-C)-lowering treatment with pitavastatin+ezetimibe in 1,734 ACS patients with dyslipidemia. Patients were divided into two groups based on EPA/AA level on admission (cut-off: 0.34 μg/mL; median of baseline EPA/AA level) and clinical outcomes were examined. Results Percent reduction of LDL-C from baseline to follow-up and mean LDL-C level during follow-up were similar regardless of baseline EPA/AA ratio. In the low EPA/AA group, the Kaplan–Meier estimate for the primary endpoint at 3 years was 27.2% in the pitavastatin+ezetimibe group, compared with 36.6% in the pitavastatin-monotherapy group [hazard ratio (HR), 0.69; 95% confidence interval (CI), 0.52–0.93; P=0.015). However, in the high EPA/AA group, there was no significant reduction in the primary endpoint by pitavastatin+ezetimibe therapy (HR, 0.92; 95% CI, 0.70–1.20; P=0.52). Conclusions Aggressive lipid-lowering therapy with ezetimibe had a positive effect on clinical outcomes in the low EPA/AA group of ACS patients with dyslipidemia, but not in the high EPA/AA group. This effect was independent of LDL-C reduction and suggests that EPA/AA measurement on admission in ACS patients contributes to a “personalized” lipid-lowering approach.

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