Hemodynamic Response to Exercise Training in Heart Failure With Reduced Ejection Fraction Patients.

Background: Supervised exercise training decreases total and cardiac mortality and increases quality of life of heart failure with reduced ejection fraction (HFrEF) patients. However, response to training is variable from one patient to another and factors responsible for a positive response to training remain unclear. The aims of the study were to compare cardiac hemodynamic changes after an exercise training program in responders (R) versus non-responders (NR) HFrEF patients, and to compare different discriminators used to assess response to training. Methods: Seventy-six HFrEF patients (86% males, 57 ± 12 years) completed an exercise training program for 4 weeks. Patients underwent cardiopulmonary exercise testing (CPET) on a cycle ergometer before and after training. Cardiac hemodynamics were measured by impedance cardiography during CPET. The R and NR groups were classified using the median change in peak oxygen uptake (V̇O2peak). Results: There were statistically significant differences in V̇O2peak (+35% vs. -1%, P < 0.0001) and in peaks of ventilation (+30% vs. +2%, P < 0.0001), cardiac output (COpeak) (+25% vs. +4%, P < 0.01), systolic blood pressure (+12% vs. +2%, P < 0.05), diastolic blood pressure (+9% vs. +4%, P < 0.05) and heart rate (+8% vs. +1%, P < 0.01) between R and NR after the training program. V̇O2peak was the best discriminator between R and NR (receiver operating characteristic (ROC) area under the curve (AUC) = 0.83, P < 0.0001), followed by COpeak (ROC AUC = 0.77, P < 0.0001). Conclusion: V̇O2peak is the best discriminator between HFrEF R and NR patients after the training program. Responders showed improvements in peak hemodynamic parameters. These results pave the way for other studies to determine how the individualization of exercise training programs and peak hemodynamic parameters potentially linked to a better positive response status.

Temporal trends in admission for cardiac rehabilitation after an acute coronary syndrome in France from 2009 to 2021: Persistent sex, age and social disparities.

BACKGROUND: Cardiac rehabilitation after an acute coronary syndrome is recommended to decrease patient morbidity and mortality and to improve quality of life. AIMS: To describe time trends in the rates of patients undergoing cardiac rehabilitation after an acute coronary syndrome in France from 2009 to 2021, and to identify possible disparities. METHODS: All patients hospitalized for acute coronary syndrome in France between January 2009 and June 2021 were identified from the national health insurance database. Cardiac rehabilitation attendance was identified within 6 months of acute coronary syndrome hospital discharge. Age-standardized cardiac rehabilitation rates were computed and stratified for sex and acute coronary syndrome subtypes (ST-segment elevation and non-ST-segment elevation). Patient characteristics and outcomes were described and compared. Factors independently associated with cardiac rehabilitation attendance were identified. RESULTS: In 2019, among 134,846 patients with an acute coronary syndrome, 22.3% underwent cardiac rehabilitation within 6 months of acute coronary syndrome hospital discharge. The mean age of patients receiving cardiac rehabilitation was 62 years. The median delay between acute coronary syndrome hospitalization and cardiac rehabilitation was 32 days, with about 60% receiving outpatient cardiac rehabilitation. Factors significantly associated with higher cardiac rehabilitation rates were male sex, younger age (35-64 years), least socially disadvantaged group, ST-segment elevation, percutaneous coronary intervention and coronary artery bypass graft. Between 2009 and 2019, cardiac rehabilitation rates increased by 40% from 15.9% to 22.3%. Despite greater upward trends in women, their cardiac rehabilitation rate was significantly lower than that for men (14.8% vs. 25.8%). In 2020, cardiac rehabilitation attendance dropped because of the coronavirus disease 2019 pandemic. CONCLUSIONS: Despite the health benefits of cardiac rehabilitation, current cardiac rehabilitation attendance after acute coronary syndrome remains insufficient in France, particularly among the elderly, women and socially disadvantaged people.

Two-year prognosis and cardiovascular disease prevention after acute coronary syndrome; the role of cardiac rehabilitation: a French nationwide study.

AIMS: To evaluate the impact of cardiac rehabilitation (CR) on optimization of secondary prevention treatments for acute coronary syndrome (ACS), medication persistence, medical follow-up, rehospitalisation, and all-cause mortality. METHODS: The national health insurance database was used to identify all patients hospitalised for ACS in France in 2019 and those among them who received CR. Patients' characteristics and outcomes were described and compared between CR and non-CR patients. Poisson regression models were used to identify the impact of CR after adjusting for confounders. A Cox model was fitted to identify the variables related to mortality after adjustment for medication persistence and cardiologic follow-up. RESULTS: In 2019, 22% of 134,846 patients hospitalised for ACS in France received CR within six months of their discharge. After one year, only 60% of patients who did not receive CR were still taking BASI drugs (combination of Beta blockers, Antiplatelets agents, Statins and RAAS Inhibitors). This rate and the medical follow-up rate were higher in patients who received CR. Two years after the ACS event, patients who received CR had better medical follow-up and lower mortality risk, after adjusting for cofounding variables (adjusted HR all-cause mortality = 0.65 [0.61-0.69]). After adjustment for the dispensing of cardiovascular drugs and cardiologic follow-up, the independent effect of CR was not as strong but remained significant (HR = 0.90 [95%CI: 0.84-0.95]). CONCLUSION: Patients who received CR after hospitalisation for ACS had a better prognosis. Optimization of efficient secondary prevention strategies, improved medication persistence, and enhanced cardiologic follow-up seemed to play a major role.

In our nationwide study of all patients hospitalized for acute coronary syndrome in 2019 (n = 134,846), 22% were admitted in cardiac rehabilitation after their hospitalisation. The admission in cardiac rehabilitation unit increased patients medication persistence, increased the chance to initiate a tobacco replacement therapy in smokers, reduced rehospitalisation risk and the recurrence of acute coronary syndrome. In addition the risk of death was reduced in the two years following the hospitalization. Health benefits associated with an admission in cardiac rehabilitation following an acute coronary syndrome are significant focusing recurrence and mortality. The correction of cardiovascular risk factors, the improvement of medication persistence and a more frequent cardiologic follow-up play a major role in these health benefits.These results should help to encourage increased referral for and patient participation in cardiac rehabilitation programs, whose rate is still very low in many countries, including France. Finally, decreasing hospital capacity means that new rehabilitation modalities need to be considered, including supervised home-based CR and tele-rehabilitation.

Health-related quality of life in elderly cardiac patients undergoing cardiac rehabilitation and the association with exercise capacity: The EU-CaRE study.

AIMS: The ability to be physically active is pivotal to the quality of life in elderly patients. This study aims to describe the association between exercise capacity and health-related quality of life (HRQoL), anxiety, and depression following an exercise-based cardiac rehabilitation (CR) program in elderly cardiac patients. METHODS: Patients aged ≥65 years with acute and chronic coronary syndrome or heart valve surgery were consecutively included from 8 CR centers in 7 European countries. Exercise capacity (VO2peak(ml/kg/min)) was assessed with a cardiopulmonary exercise test (97%) or a six-minute walk test. Outcome variables included HRQoL (SF-36 physical and mental component scores (PCS and MCS)), anxiety (GAD-7), and depression (PHQ-9). Mixed models were used to address the association between baseline and the development in VO2peak, and outcome variables stratified on sex, and adjusted for baseline values, age, and CR center. RESULTS: A total of 1,633 patients were included (T0), 1,523 (93%) completed end-of-CR assessment (T1), and 1,457 (89%) 1-year follow-up (T2). Women had higher % of predicted VO2peak, but poorer scores in HRQoL, anxiety and depression at all time-points. All scores improved in both sexes at follow-up. We found significant associations between VO2peak at baseline as well as development in VO2peak and all outcome variables at T1 and T2 in men (all p < 0.001). In women, VO2peak was only associated with PCS scores (p < 0.001). CONCLUSIONS: Improvements in exercise capacity was strongly associated with improvements in HRQoL and mental health, however with stronger associations in men. The results highlight the importance of physical fitness for HRQol and mental health. The findings from this study might be useful to better target individual CR programs.

This study explores the association between exercise capacity and the well-being of elderly cardiac patients participating in a cardiac rehabilitation program, focusing on health-related quality of life (HRQoL), anxiety, and depression. Key Findings:Women, despite having higher percentages of predicted exercise capacity, consistently reported poorer HRQoL, anxiety, and depression scores compared to men at all assessed time points.Improvements in exercise capacity were strongly associated with positive changes in HRQoL and mental health, with these associations being more pronounced in men.

La anemia influye en la capacidad de ejercicio sin comprometer el beneficio de la rehabilitación cardíaca en pacientes con insuficiencia cardíaca / Anemia affects exercise capacity without compromising the benefits of cardiac rehabilitation in patients with heart failure / Anemia afeta a capacidade de exercício, sem comprometer os benefícios da reabilitação cardíaca em pacientes com insuficiência cardíaca

Introducción. La anemia en los pacientes con insuficiencia cardíaca (IC) crónica es un factor predictivo independiente de mortalidad y su prevalencia aumenta con la severidad de la IC. Objetivo. Evaluar en forma prospectiva el impacto de los valores de hemoglobina (Hb) sobre la capacidad de ejercicio basal y los resultados del reentrenamiento físico en pacientes con disfunción sistólica de ventrículo izquierdo. Material y métodos. Se incluyeron 246 pacientes con IC de diferentes etiologías con una edad media de 56 ± 12 años con una fracción de eyección <40%. Se consideraron anémicos todos los pacientes de sexo masculinos con una Hb <13 g/L y menor a <12g/L en las mujeres. Todos los pacientes realizaron un programa de entrenamiento físico en cicloergómetro con una media de 20 sesiones. Resultados. El 55,7% de los pacientes era anémico. Las tasas de Hb no difirieron antes ni después del programa de rehabilitación en ninguno de los dos grupos. La presencia de la anemia influyó de manera negativa en la capacidad de esfuerzo medida por la duración del esfuerzo (5,08 ± 2,4 vs 5,9 ± 2,9 minutos; p=0,001), la carga máxima (68,3 ± 22,8 vs 80,2 ± 27,7 watts; p=0,0005) o el pico de consumo de oxígeno (14,9 ± 4,4 vs 16,9 ± 5,4 ml/kg/min; p=0,0001). El porcentaje de ganancia de capacidad de esfuerzo por entrenamiento es comparable en los dos grupos: 20,1± 22,1% y 18,9 ± 22,8%. Conclusión. En pacientes con IC, la anemia es responsable de modificaciones metabólicas, bioquímicas y funcionales que conducen a un agravamiento de la disfunción ventricular izquierda, a una reducción de las capacidades físicas y consecuentemente a un empeoramiento de la calidad de vida. Sin embargo, los beneficios obtenidos por la rehabilitación son similares en pacientes anémicos y no anémicos.

Introduction. Anemia in chronic heart failure (HF) patients is an independent predictor of mortality and its prevalence increases with the severity of HF. Objectives. Prospectively assess the impact of hemoglobin (Hb) levels on the baseline exercise capacity and physical retraining results in patients with left ventricular systolic dysfunction. Methods and material. We included 246 patients with heart failure of different etiologies with a mean age 56 ± 12 years with an ejection fraction <40%. All were considered anemic male patients with Hb <13 g/L and less than <12 g/L in women. All patients underwent a physical training program in cycloergometer with an average of 20 sessions. Results. The 55.7% of patients was anemic. Hb rates did not differ before or after the rehabilitation program in any of the two groups. The presence of anemia negatively influenced in exercise capacity measured by the exercise duration (5.08 ± 2.4 vs 5.9 ± 2.9 minutes, P=0.001), maximum load (68.3 ± 22.8 vs 80.2 ± 27.7 watts, p=0.0005) or peak oxygen consumption (14.9 ± 4.4 vs 16.9 ± 5.4 ml/kg/min, P=0.0001). The percentage gain in exercise capacity by training is comparable in both groups: 20.1 ± 22.1% and 18.9 ± 22.8%. Conclusion. In patients with HF, anemia is responsible for metabolic, biochemical, and functional modifications, leading to a worsening of left ventricular dysfunction, a reduction of physical capacities and consequently deterioration in the quality of life. However, the rehabilitation benefits are similar in anemic and non anemic patients.

Introdução. A Anemia em pacientes com insuficiência cardíaca (IC) crônica é um preditor independente de mortalidade e sua prevalência aumenta com a gravidade da IC. Objetivos. Prospectivamente avaliar o impacto dos níveis de hemoglobina (Hb) na capacidade de exercício de referência e resultados de reciclagem física em pacientes com disfunção sistólica ventricular esquerda. Material e métodos. Foram incluídos 246 pacientes com insuficiência cardíaca de diferentes etiologias, com idade média de 56 ± 12 anos, com fração de ejeção <40%. Foram considerados anêmicos todos os pacientes do sexo masculino com uma Hb <13 g/L, e menos de <12 g/L em mulheres. Todos os pacientes foram submetidos a um programa de treinamento físico em cicloergômetro com uma média de 20 sessões. Resultados. O 55,7% dos pacientes estava anêmico. As taxas de Hb não diferiram antes ou depois do programa de reabilitação em qualquer um dos dois grupos. A presença de anemia afeta negativamente na capacidade de exercício medida pela duração do esforço (5,08 ± 2,4 vs 5,9 ± 2,9 minutos, P=0,001) de carga, máxima (68,3 ± 22,8 vs 80,2 ± 27,7 watts, p=0,0005) ou pico de consumo de oxigênio (14,9 ± 4,4 vs 16,9 ± 5,4 ml/kg/min, P=0,0001). O ganho percentual da capacidade de exercício de treinamento é comparável em ambos os grupos: 20,1 ± 22,1% e 18,9 ± 22,8%. Conclusão. Em pacientes com insuficiência cardíaca, a anemia é responsável por alterações metabólicas, bioquímicas e funcionais, levando a um agravamento da disfunção ventricular esquerda, uma redução de capacidades físicas e, conseqüentemente, a um declínio na qualidade de vida. No entanto, os benefícios de reabilitação são semelhantes em anêmicos e não anêmicos.