scholarly journals Cardiovascular prevention and rehabilitation in the elderly: evidence for cardiac rehabilitation after myocardial infarction or chronic heart failure

2016 ◽  
Vol 84 (1-2) ◽  
Author(s):  
Francesco Fattirolli ◽  
Alessandra Pratesi
Keyword(s):  
Heart Failure ◽  
Cardiac Rehabilitation ◽  
Functional Dependence ◽  
Cardiovascular Prevention ◽  
The Elderly ◽  
Medical Community ◽  
Coronary Syndrome ◽  
Esercizio Fisico ◽  
Sindrome Coronarica Acuta

<p>Cardiac rehabilitation in the elderly today often represents a utopia. The international scientific literature takes little into account this type of prescription for old people, although they represent a large and growing proportion of cardiac patients, with acute coronary syndrome or heart failure, which we have to manage in everyday life. Furthermore, interventions of health education, clinical follow up, rehospitalisation prevention and prescription of tailored exercise, are sometimes more necessary in this kind of patients, given the presence of multimorbidity, functional dependence, frailty, sarcopenia, social neglect. Most of the data on the feasibility, safety and efficacy of cardiac rehabilitation are favourable, but they are few and apparently not strong enough to convince the medical community. Therefore is necessary to join efforts to identify the geriatric patient's peculiarities and plan a suitable program of cardiac rehabilitation, which takes into account the multi-dimensionality and complexity of typical problems of the elderly, for which the classical cardiac outcomes can be limited.</p><p><strong>Riassunto</strong></p><p>La riabilitazione cardiologica nel paziente anziano rappresenta ad oggi in molte realtà una utopia. La letteratura scientifica internazionale prende poco in considerazione questo tipo di prescrizione nei soggetti in età avanzata, per quanto essi rappresentino una grande e crescente quota dei pazienti cardiopatici con sindrome coronarica acuta o scompenso cardiaco. Inoltre proprio su questa tipologia di pazienti interventi di educazione sanitaria, monitoraggio clinico e prescrizione di esercizio fisico personalizzato, risultano più necessari, data la presenza di multimorbilità, dipendenza funzionale, fragilità, sarcopenia, isolamento sociale. La maggior parte dei dati su fattibilità, sicurezza ed efficacia della riabilitazione cardiologica dopo infarto miocardico e nello scompenso sono favorevoli, ma risultano limitati nella numerosità delle casistiche e non condotti su pazienti assimilabili a quelli del mondo reale. E’ necessario dunque identificare le peculiarità del paziente geriatrico e pianificare e personalizzare un programma di riabilitazione cardiologica che tenga in considerazione la multidimensionalità e la complessità dei problemi tipici del soggetto anziano, per il quale gli outcome cardiologici abituali possono risultare limitati o non significativi.</p>

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

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&lt;0.001), CABG (11% v 2%, p&lt;0.001) and a diagnosis of STEMI (21% v 5%, p&lt;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&lt;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&lt;0.001), statins (91% 73%, p&lt;0.001), beta-blockers (11% v 13%, p=0.002) and ACEI/ARBs (72% v 61%, p&lt;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

B-Type natriuretic peptide predicts major adverse cardiac and cerebrovascular events after catheter ablation of atrial fibrillation: insights from AF frontier ablation registry

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
T Kato ◽  
K Usuda ◽  
H Tada ◽  
T Tsuda ◽  
K Takeuchi ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Natriuretic Peptide ◽  
Cardiovascular Events ◽  
Curve Analysis ◽  
Funding Source ◽  
Coronary Syndrome ◽  
Cerebrovascular Events

Abstract Background High plasma B-Type natriuretic peptide (BNP) level is associated with cardiac events or stroke in patients with atrial fibrillation (AF). However, it is still unknown whether BNP predicts worse clinical outcomes after catheter ablation ofAF. Purpose We aimed to see if plasma BNP level is associated with major adverse cardiac and cerebrovascular events (MACCE) after catheter ablation of AF. Methods We retrospectively analyzed 1,853 participants (73.1% men, mean age 63.3±10.3 years, 60.7% paroxysmal AF) who received first catheter ablation of AF with pre-ablation plasma BNP level measurement and completed follow-up more than 3 months after the procedure from AF Frontier Ablation Registry, a multicenter cohort study in Japan. We evaluated an association between plasma BNP level before catheter ablation and first MACCE in cox-regression hazard models adjusted for known risk factors. MACCE were defined as stroke/transient ischemic attack (TIA), cardiovascular events or all-cause death. Results The mean plasma BNP level was 120.2±3.7 pg/mL. During a mean follow-up period of 21.9 months, 57 patients (3.1%) suffered MACCE (ischemic stroke 8 [14.0%], hemorrhagic stroke 5 [8.8%], TIA 5 [8.8%], hospitalization for heart failure 11 [19.2%], acute coronary syndrome 9 [15.8%], hospitalization for other cardiovascular events 8 [14.0%] and all-cause death 11 [19.2%]). Plasma BNP level of patients with MACCE were significantly higher than those without MACCE (291.7±47.0 vs 114.7±3.42 pg/mL, P&lt;0.001). Multivariate analysis revealed that plasma BNP level (hazard ratio [HR] per 10 pg/mL increase 1.014; 95% confidence interval [CI] 1.005–1.023; P=0.001), baseline age (HR 1.052; 95% CI 1.022–1.084; P=0.001), heart failure (HR 2.698; 95% CI 1.512–4.815; P=0.001), old myocardial infarction (HR 3.593; 95% CI 1.675–7.708; P=0.001) and non-ischemic cardiomyopathy (HR 2.676; 95% CI 1.337 - 5.355; P=0.005) were independently associated with MACCE. At receiver-operating characteristic curve analysis, plasma BNP level before catheter ablation ≥162.7 pg/mL was the best threshold to predict MACCE (area under the curve: 0.71). Kaplan-Meier curve analysis (Figure) showed that the cumulative incidence of MACCE was significantly higher in patients with a BNP ≥162.7 pg/mL than in those with a BNP below 162.7 pg/mL (HR 4.85; 95% CI 2.86–8.21; P&lt;0.001). Conclusions Elevation of plasma BNP level was independently related to the increased risk of MACCE after catheter ablation ofAF. Funding Acknowledgement Type of funding source: Private company. Main funding source(s): Bristol-Meiers Squibb

Cardiac Rehabilitation after an Acute Coronary Syndrome: The Impact in Elderly Patients

Cardiology ◽  
2015 ◽  
Vol 131 (3) ◽  
pp. 177-185 ◽  
Author(s):  
Patrícia Rodrigues ◽  
Mário Santos ◽  
Maria João Sousa ◽  
Bruno Brochado ◽  
Diana Anjo ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Cardiac Rehabilitation ◽  
Functional Capacity ◽  
Heart Rate Recovery ◽  
Real Life ◽  
The Elderly ◽  
Chronotropic Response ◽  
Coronary Syndrome ◽  
Supervised Exercise ◽  
The Impact

Introduction: Cardiac rehabilitation (CR) has been shown to decrease mortality and morbidity, improve the control of risk factors and the quality of life of patients with coronary artery disease. However, the elderly are underrepresented in most studies and in real-life CR programs. Our goal was to evaluate the impact of CR after an acute coronary syndrome in the elderly population. Methods: A cutoff of 65 years was used to dichotomize age. Our main focus was on the effects of ambulatory supervised exercise training on several surrogate markers, namely total cholesterol, low- and high-density lipoprotein cholesterol, triglycerides, body mass index, fasting glucose, glycated hemoglobin, probrain natriuretic peptide, International Physical Activity Questionnaire score, maximal exercise capacity, chronotropic response index and heart rate recovery. We evaluated those variables at the beginning and at the end of phase II of the CR program (after 3 months) and repeated the treadmill test at 12 months. Results: A total of 548 patients with a recent acute coronary syndrome were enrolled; 37% were 65 years old or older. Both age groups had a statistically significant improvement in all the evaluated parameters. Interestingly, at 12 months both groups maintained the improvement in functional capacity seen immediately after 3 months. Conclusions: The benefits of CR in terms of functional capacity, metabolic profile and other prognostic parameters were significant in both younger and older patients. Therefore, all eligible patients should be referred to CR programs, irrespective of age.

P6218Greater burden of risk factors and need of cardiac rehabilitation in elderly patients with lower educational attainment

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
I Kjesbu ◽  
N Mikkelsen ◽  
K Sibilitz ◽  
M Wilhelm ◽  
C P Gil ◽  
...  
Keyword(s):  
Risk Factors ◽  
Educational Attainment ◽  
Cardiac Rehabilitation ◽  
Medical Treatment ◽  
Exercise Capacity ◽  
Basic Education ◽  
The Elderly ◽  
P Value ◽  
Ageing Population ◽  
Coronary Syndrome

Abstract Background A socioeconomic gap in cardiac rehabilitation (CR) has been described in younger populations but whether this is also true in the ageing population is unknown. Purpose To describe if poorer education is a predictor for exercise capacity, comorbidity, lifestyle- and risk factors and medical treatment at baseline in CR in an elderly population. Methods The observational EU-CaRE study is a European prospective study with eight participating CR centers in seven countries (Denmark, France, Germany, the Netherlands, Italy, Spain and Switzerland). Patients aged 65 or older with CHD or valve surgery participating in CR were consecutively included. Educational attainment was divided into basic, intermediate and high Results A total of 1626 patients were included. Educational attainment differed across centers (p<0.001). The groups differed little regarding index event, comorbidity and medical treatment. However, patients with only basic education had more diabetes, higher BMI, less physical activity, lower exercise capacity and higher scores for depression (PHQ 9) and anxiety (GAD). Differences were not affected by adjustment for age, gender and country. Demographics and risk factor control N=1626 High (N=388) Intermediate (N=788) Basic (N=460) p-value* DEMOGRAPHICS Age (yrs), median (IQR) 72 (68, 76) 71 (68, 75) 74 (70, 78) <0.001 Men 330 (86.8%) 603 (79.3%) 291 (67.4%) <0.001 RISK FACTORS p-value** LDL >1.8 mmol/l*** 255 (66.1%) 518 (66.8%) 293 (63.7%) 0.060 Systolic BP >140 mmHg 85 (22.0%) 179 (23.1%) 100 (21.7%) 0.601 Smoker 26 (6.8%) 80 (10.3%) 46 (10.0%) 0.214 Moderate exercise <4days/week 179 (46.4%) 340 (43.9%) 271 (58.9%) 0.024 BMI >27 kg/m2 133 (35.5%) 389 (50.2%) 255 (55.4%) <0.001 VO2 peak <80% of predicted 220 (57.0%) 443 (57.2%) 252 (54.8%) 0.037 HbA1c >48mmol/mol*** 115 (29.8%) 264 (34.1%) 230 (50.0%) <0.001 Diet score, mean (SD) 6.50 (2.28) 5.93 (2.47) 7.32 (2.35) <0.001 GAD score, median (IQR) 2.0 (0.0,4.0) 2.0 (0.0,5.0) 3.5 (0.0,7.0) 0.051 PHQ-9 score, median (IQR) 4.0 (1.0,7.0) 4.0 (1.0,7.0) 6.0 (2.0,10.0) 0.020 Abbreviations: IQR, interquartile range; SD, standard deviation; ACS, acute coronary syndrome; CAD, coronary artery disease. *Adjusted for center. **Adjusted for center, age, gender. ***Only for ischemic heart disease patients. Conclusions The results emphasize the need of CR in this patient-group and that a targeted CR approach should be considered to achieve equal health opportunities also in the elderly. Acknowledgement/Funding Horizon2020

P5524Influence of bundle branch block in the long-term outcome of patients with acute coronary syndrome

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
J M Garcia Acuna ◽  
A Cordero Fort ◽  
A Martinez ◽  
P Antunez ◽  
M Perez Dominguez ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Acute Coronary Syndrome ◽  
Right Bundle Branch Block ◽  
Coronary Revascularization ◽  
Bundle Branch Block ◽  
Coronary Syndrome ◽  
Worse Prognosis

Abstract The new European Society of Cardiology guideline for ST-segment elevation myocardial infarction recommends that left and right bundle branch block should be considered equal for recommending urgent angiography in patients with suspected myocardial infarction. This consideration is not taken into account in the management of patients with coronary syndrome without ST elevation (NSTEMI). We evaluate the evolution of patients with acute coronary syndrome and long-term bundle branch block. Patients and methods We included 8771 patients admitted to two tertiary hospitals between 2003 and 2017 with an acute coronary syndrome, 5673 NSTEMI (64.3%) and 3098 STEMI (35.7%). All patients had an ECG recorded immediately upon admission. Patients were classified as having right bundle branch block (RBBB), left bundle branch block (LBBB). Long-term follow-up was performed (median 55 months) to assess mortality. Results A total of 8771 patients were included with a mean age of 66.1 years, 72.5% males, 4.1% (362) with LBBB and 5% (440) with RBBB. Patients with BBB were older, with more previous history of myocardial infarction and coronary revascularization and higher prevalence of cardiovascular risk factors. Medical treatment was similar but they were less often submitted to angioplasty. During the acute phase, patients with RBBB and LBBB presented a higher rate of heart failure than those without branch block (4.8% vs 9.1% vs 3.5%, p=0.0001); higher mortality (8.4% vs 10.5% vs 3.0%, p=0.0001); higher stroke rate (2.5% vs 1.4% vs 0.8%, p=0.001); higher rate of renal failure (8.2% vs 9.7% vs 3.9%, p=0.0001) and higher rate of reinfarction (3.0% vs 4.1% vs 1.7%, p=0.001). Patients who had a RBBB or an LBBB had a worse prognosis throughout the follow-up. Heart failure was present in 17.7% of the group with RBBB, 29.6% of LBBB and 11% in the group without branch block (p=0.0001). Mortality during follow-up was 31% in RBBB, 40.6% in LBBB and 18.7% without branch block (p=0.0001). In multivariate analysis of Cox, both RBBB (HR 1.55, 95% CI 1.23–1.98, p=0.0001) and LBBB (HR 1.48, 95% CI 1.22–1.53, p=0.001) were an independent predictors of all-cause mortality (adjustment for GRACE score, gender, treatment with betablockers, angiotensin conversor enzym inhibitors, statin and coronary revascularization). Cox regression model multivariate Conclusions The presence of RBBB or LBBB in the ECG of patients with an ACS is associated with a worse prognosis both during the hospital phase and in the long term. In addition, both bundle branch blocks are independent predictors of long-term mortality in patients with ACS.

scholarly journals Spontaneous coronary artery dissection: Rare but challenging

2014 ◽  
Vol 71 (3) ◽  
pp. 311-316
Author(s):  
Biljana Putnikovic ◽  
Ivan Ilic ◽  
Milos Panic ◽  
Aleksandar Aleksic ◽  
Radosav Vidakovic ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Blood Flow ◽  
Coronary Artery ◽  
Coronary Angiography ◽  
Artery Dissection ◽  
Spontaneous Coronary Artery Dissection ◽  
Coronary Artery Dissection ◽  
Coronary Syndrome

Introduction. Spontaneous coronary artery dissection (SCAD) is a rare cause of the acute coronary syndrome. It occurs mostly in patients without atherosclerotic coronary artery disease, carrying fairly high early mortality rate. The treatment of choice (interventional, surgical, or medical) for this serious condition is not well-defined. Case report. A 41-year old woman was admitted to our hospital after the initial, unsuccessful thrombolytic treatment for anterior myocardial infarction administered in a local hospital without cardiac catheterization laboratory. Immediate coronary angiography showed spontaneous coronary dissection of the left main and left anterior descending coronary artery. Follow-up coronary angiography performed 5 days after, showed extension of the dissection into the circumflex artery. Because of preserved coronary blood flow (thrombolysis in myocardial infarction - TIMI II-III), and the absence of angina and heart failure symptoms, the patient was treated medicaly with dual antiplatelet therapy, a low molecular weight heparin, a beta-blocker, an angiotensinconverting enzyme (ACE) inhibitor and a statin. The patient was discharged after 12 days. On follow-up visits after 6 months and 2 years, the patient was asymptomatic, and coronary angiography showed the persistence of dissection with preserved coronary blood flow. Conclusion. Immediate coronary angiography is necessary to assess the coronary anatomy and extent of SCAD. In patients free of angina or heart failure symptoms, with preserved coronary artery blood flow, medical therapy is a viable option. Further evidence is needed to clarify optimal treatment strategy for this rare cause of acute coronary syndrome.

Can left ventricular global function index be a novel marker of unfavorable outcome in patients with acute coronary syndrome

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
L Minushkina ◽  
V Brazhnik ◽  
N Selezneva ◽  
V Safarjan ◽  
M Alekhin ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Myocardial Infarction ◽  
Heart Failure ◽  
Acute Coronary Syndrome ◽  
Left Ventricular ◽  
Global Function ◽  
Coronary Syndrome ◽  
History Of ◽  
Coronary Events

Abstract   Left ventricular (LV) global function index (LVGFI) is a MRI marker of left ventricular remodeling. LVGFI has high predictive significance in young healthy individuals. The aim of the study was to assess prognostic significance in patients with acute coronary syndrome (ACS). We include into this analysis 2169 patients with ACS (1340 (61.8%) men and 829 (38.2%) women), mean age 64.08±12.601 years. All patients were observed in 2 Russian multicenter observational studies: ORACLE I (ObseRvation after Acute Coronary syndrome for deveLopment of trEatment options) (2004–2007 years) and ORACLE II (NCT04068909) (2014–2019 years). 1886 (87.0%) pts had arterial hypertension, 1539 (71.0%) – history of coronary artery disease, 647 (29.8%) – history of myocardial infarction, 444 (20.5%) - diabetes mellitus. Duration of the follow-up was 1 years after the hospital discharge. Cases of death from any cause, coronary deaths, repeated coronary events (fatal and non-fatal) were recorded. An echocardiographic study was conducted 5–7 days from the time of hospitalization. The LVGFI was defined as LV stroke volume/LV global volume × 100, where LV global volume was the sum of the LV mean cavity volume ((LV end-diastolic volume + LV end-systolic volume)/2) and myocardial volume (LV mass/density). During the follow-up, 193 deaths were recorded (8.9%), 122 deaths (5.6%) were coronary. In total, repeated coronary events were recorded in 253 (11.7%) patients. Mean LVGFI was 22.64±8.121%. Patients who died during the follow-up were older (73.03±10.936 years and 63.15±12.429 years, p=0.001), had a higher blood glucose level at the admission to the hospital (8.12±3.887 mmol/L and 7.17±3.355 mmol/L, p=0.041), serum creatinine (110.86±53.954 μmol/L and 99.25±30.273 μmol/L, p=0.007), maximum systolic blood pressure (196.3±25.17 mm Hg and 190.3±27.83 mm Hg, p=0.042). Those who died had a lower LVGFI value (19.75±6.77% and 23.01±8.243%, p&lt;0.001). Myocardial mass index, ejection fraction and other left ventricular parameters did not significantly differ between died and alive patients. Among the patients who died, there were higher rate of women, pts with a history of myocardial infarction, heart failure, diabetes. In a multivariate analysis, diabetes mellitus OR1.67 95% CI [1.12–2.51] p=0.012, history of heart failure (1.78 [1.2.-2.59], p=0.003), a history of myocardial infarction (1.47 [1.05–2.05], p=0024), age (1.06 [1.05–1.08], p=0.001) and LVGFI &lt;22% (1.53 [1.08–2.17], p=0.015) were independent predictors of death from any cause. The LVGFI was also independently associated with the risk of coronary death, but not with the risk of all recurring coronary events. Thus, LVGFI may be useful the marker to assess risk in patients who have experienced an ACS episode. Funding Acknowledgement Type of funding source: None

Cardiac rehabilitation in the elderly patient in eight rehabilitation units in Western Europe: Baseline data from the EU-CaRE multicentre observational study

2019 ◽  
Vol 26 (10) ◽  
pp. 1052-1063 ◽  
Author(s):  
Eva Prescott ◽  
Nicolai Mikkelsen ◽  
Annette Holdgaard ◽  
Prisca Eser ◽  
Thimo Marcin ◽  
...  
Keyword(s):  
Risk Factors ◽  
Coronary Artery ◽  
Cardiac Rehabilitation ◽  
Western Europe ◽  
Stable Coronary Artery Disease ◽  
The Elderly ◽  
Risk Factor Control ◽  
Coronary Syndrome ◽  
Artery Disease ◽  
The Eu

Background Due to the progressive deconditioning, comorbidities and higher complication rates, elderly patients are in particular need of cardiac rehabilitation. We compared elderly patients (65+ years old) participating in cardiac rehabilitation, focusing on baseline characteristics, risk factor control and functional assessment. Methods The EU-CaRE study is a prospective study comparing cardiac rehabilitation in eight centres across Western Europe. Consecutive patients with acute coronary syndrome, stable coronary artery disease and heart valve replacement undergoing cardiac rehabilitation were included. Results Of 1633 patients (median age 72 years) participating, 54% had acute coronary syndrome, 33% had stable coronary artery disease and 13% followed valve replacement. Fifty-five per cent had undergone percutaneous coronary intervention and 29% coronary artery bypass grafting. Characteristics varied across centres: 23% (17–27%) were women, 4% (0–12%) were of non-European origin and 16% (4–32%) were living alone. Median time from index event to start of cardiac rehabilitation varied from 11 to 49 days ( p < 0.001). Mean VO2peak was relatively low (16 mL/kg per min) and varied significantly between the participating centres, largely unaffected by multivariable adjustment. Overall patients received guideline recommended treatment: 93% (87–97%) were on a statin and 70% (55–85%) an angiotensin-converting enzyme inhibitor/angiotensin receptor blocker. However, risk factor control was inadequate: 58% had three or more risk factors not controlled. Conclusion EU-CaRE provides a snapshot of the elderly population with heart disease participating in cardiac rehabilitation across countries in Western Europe. Risk factors and exercise capacity indicate the continued need for cardiac rehabilitation in these patients. Of concern, the lag-time to start of cardiac rehabilitation needs improvement in many centres.

P6471Pronostic impact of significant valvular disease in long-term survivors of out-of-hospital-cardiac arrest

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
L Rodriguez ◽  
J Caro-Codon ◽  
J R Rey-Blas ◽  
S O Rosillo ◽  
O Gonzalez ◽  
...  
Keyword(s):  
Heart Failure ◽  
Cardiac Arrest ◽  
Hospital Discharge ◽  
Percutaneous Treatment ◽  
Valvular Disease ◽  
Temperature Management ◽  
P Value ◽  
Coronary Syndrome ◽  
Hospital Cardiac Arrest

Abstract Background There is scarce evidence about the prevalence and clinical relevance of moderate to severe valvular heart disease (VHD) in survivors of out of hospital cardiac arrest (OHCA). Purpose To determine whether VHD influence prognosis of OHCA survivors. Methods All consecutive patients admitted to the Acute Cardiac Care Unit after OHCA and surviving until hospital discharge were included. All patients received targeted-temperature management according to our local protocol. Univariate and multivariate Cox-proportional hazard models were employed. Results A total of 201 patients were included in the analysis. Mean age was 57.6±14.2 years and 168 (83.6%) were male. Eighteen patients (9.0%) had moderate or severe VHD during index admission (Table 1). Patients with VHD were less frequently of male sex, [11 (61.1%) vs 157 (85.8%), p=0.014], experienced less acute coronary syndrome-related arrhytmias [2 (11.1%) vs 85 (46.5%), p=0.005], and had a lower pH at hospital admission (6.9±1.6 vs 7.2±0.15, p=0.008). During a median follow-up of 40.3 (18.9–69.1) months, patients with VHD showed higher mortality [7 (38.9%) vs 28 (15.3%), p=0.004] and more heart failure-related admissions [7 (38.9%) vs 15 (8.2%), p<0.001]. Only five patients received surgical or percutaneous treatment for VHD during follow-up, with no deaths in this subgroup. Moderate or severe VHD proved to be an independent predictor of global cardiovascular events and specifically heart failure episodes (Figure 1). Table1 Variable With valvular disease Without valvular disease p value Age, mean±DS, years 63.5±13.2 57.0±14.1 0.066 Hypertension, n (%) 12 (66.7) 95 (51.9) 0.231 Diabetes, n (%) 5 (27.8) 24 (13.1) 0.149 Dyslipidaemia, n (%) 7 (38.9) 79 (43.2) 0.726 Smokin habit, n (%) 4 (22.2) 90 (49.2) 0.045 Witnessed cardiac arrest, n (%) 18 (100) 175 (95.6) 1.000 Time from CA to ROSC, mean±DS, minute 19.1±7.5 21.2±13.1 0.506 Shockable rhythm, n (%) 13 (72.2) 163 (89.1) 0.055 LVEF at hospital discharge (%) 42.8±12.1 46.9±14.6 0.254 Figure 1 Conclusion The presence of significant VHD in survivors after OHCA is a predictor of poor outcomes. Specific management of VHD may be specially relevant in this high-risk patients and guideline-oriented therapy, including surgery and percutaneous intervention should be encouraged when indicated.

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