Exercise as a Therapeutic Tool in Age-Related Frailty and Cardiovascular Disease: Challenges and Strategies.

Understanding the link between heart disease and frailty in older adults is crucial. Although medical progress has extended life, it has not fully addressed the decline in function and quality of life in frail older people. Frailty is a state of vulnerability to health stressors that needs comprehensive solutions. Its assessment within health care, especially in cardiology, is important owing to its association with worse clinical outcomes. Recent evidence and guidelines suggest that the prescription of a comprehensive exercise regimen, tailored to progressively include strength, balance, mobility, and endurance training improves adherence, functionality, and health-related quality of life, in both acute and chronic cardiovascular diseases. In addition, exercise is a vital tool that improves function, targets frailty, and holistically affects the body's systems. Still, many frail people do not exercise enough, and when they do, they usually do not follow an appropriate plan tailored for better functional outcomes. Overcoming barriers and limitations in exercise enrollment and adherence through strategies such as automated cardiac rehabilitation referral, patient education, and eHealth tools can notably improve clinical outcomes.

The Hospital Zambrano Hellion venous thromboembolism rapid response team (PREVENTION-team): Improving pulmonary embolism and deep venous thrombosis patient care / Equipo de respuesta rápida para tromboembolismo venoso del Hospital Zambrano Hellion (PREVENTION-Team): Mejorando el manejo del tromboembolismo pulmonar y trombosis venosa profunda

Abstract Background: Fast-track worldwide reperfusion programs improve outcomes in ST-elevation myocardial infarction and stroke. Similar programs called Program Evaluation and Review Technique (PERT) focus on submassive and massive pulmonary embolism (PE) excluding deep venous thrombosis (DVT). Methods: PREVENTION-team (Hospital Zambrano Hellion Venous Thromboembolism [VTE] Rapid Response). Primary objective: Fast-track stratification, diagnostics, and treatment (60-90 min) to improve proximal DVT and submassive and massive PE patients care. Secondary objectives: Increase diagnosis rate of low-risk PE and distal DVT; exploration of cause; long-term anticoagulation; identify high-risk profile for chronic complications; community-based support groups and patient education to extend the concept of the thrombosis-free hospital to thrombosis-free home. Structure and organization: The team includes cardiologists, vascular medicine, angiologist, echocardiographer, cardiovascular imaging, and interventional cardiologists. The team will be accessible 24 h a day, 7 days a week, 365 days a year, and base on previous national experience. The cardiology fellow on call will be responsible for activation and evaluation. We will design several tools to accelerate these processes. Risk stratification and therapeutic approach will be based on clinical presentation, echocardiogram, and biomarkers findings. According to PERT stratification based on resources and medical specialties, Hospital Zambrano Hellion has level 1 PERT. PREVENTION-team links physicians with different expertise, provide fast, efficient, and time-saving treatment, potentially saving lives and reducing bleeding and chronic complications in VTE patients. Finally, establishing a network in our hospital and health system to improve VTE patients care. To the best of our knowledge, this is the first rapid response team focused on VTE in Mexico.

Resumen Antecedentes: Programas de reperfusión mejoraron la evolución en infarto con elevación del ST y accidente cerebrovascular embólico. Programas similares llamados PERT para TEP masiva o submasiva excluyen TVP. Métodos: Equipo PREVENTION (Hospital Zambrano Hellion Venous Thromboembolism Rapid Response). Objetivo primario: Estratificación, diagnóstico y tratamiento acelerado (60-90 minutos) para mejorar atención del TVP proximal y TEP masiva o submasiva. Objetivos secundarios: Incrementar diagnóstico de TEP de riesgo bajo y TVP distal; explorar causa; anticoagulación a largo plazo; perfil de riesgo alto para complicaciones crónicas; grupos de soporte en la comunidad y educación para pacientes, y extender el concepto de hospital libre de trombosis a hogar libre de trombosis. Estructura y organización: Incluye cardiólogos, medicina vascular, angiólogo, ecocardiografistas, imagen cardiovascular. Basado en experiencia nacional, el equipo estará accesible 24 horas del día, siete días de la semana, 365 días del año. El residente de cardiología realizará la activación y estratificación. Diseñamos herramientas para acelerar el proceso. La estratificación de riesgo y el abordaje terapéutico se basará en presentación clínica, hallazgos ecocardiograficos y biomarcadores. El Hospital Zambrano Hellion tiene nivel PERT 1 de acuerdo a la estratificación PERT basada en recursos y especialidades. Equipo-PREVENTION en TEV vincula médicos con diferentes capacidades, ofrece rápido y eficiente tratamiento para preservar vidas y reducir complicaciones hemorrágicas y crónicas. En nuestro hospital y sistema de salud establecer una sólida red de trabajo para mejorar la atención. Hasta nuestro conocimiento, en México este podría ser el primer equipo de respuesta rápida enfocado en TEV.