[Cardiac rehabilitation : a multidisciplinary program of cardiovascular prevention of essential importance]. / La réadaptation cardiaque : un programme multidisciplinaire de prévention cardiovasculaire indispensable.

Cardiovascular diseases and especially coronary artery disease remain the first cause of mortality in Switzerland. Comprehensive cardiac rehabilitation is a validated multidisciplinary intervention, which represents the most appropriate strategy of implementing an effective secondary cardiovascular prevention to reduce the impact of cardiovascular diseases. However, less than half of patients after a myocardial infarction and a tiny proportion of patients with heart failure participate in a rehabilitation program in our country. This article summarizes the current state of cardiac rehabilitation in Switzerland, as well as future developments of cardiac tele-rehabilitation that have accelerated due to the COVID-19 pandemic.

Les maladies cardiovasculaires, et en premier lieu la maladie coronarienne, restent la première cause de mortalité en Suisse. La réadaptation cardiaque intégrée est une intervention multidisciplinaire validée représentant le meilleur moyen de mettre en place une stratégie de prévention cardiovasculaire secondaire efficace pour réduire l'impact des maladies cardiovasculaires. Pourtant, moins de la moitié des patients victimes d'un infarctus du myocarde et une proportion infime de patients atteints d'une insuffisance cardiaque participent à un programme de réadaptation cardiaque dans notre pays. Cet article résume l'état actuel de la réadaptation cardiaque en Suisse ainsi que les futurs développements de téléréadaptation cardiaque qui se sont accélérés dans le contexte de la pandémie de Covid-19.

[Long-term physical activity after a myocardial infarction : a permanent challenge]. / Activité physique au long cours après un infarctus du myocarde : un défi permanent.

Cardiac rehabilitation is a well-defined multidisciplinary program with the objective to reduce mortality and morbidity, while also improving the exercise capacity and quality of life of the patient following a myocardial infarction. Despite the fact that a cardiovascular rehabilitation program is now recommended by international guidelines for all patients who have suffered from an acute coronary syndrome, only half of all patients actually participate to such a program in Switzerland. Even worse, especially when taking into consideration the population in Geneva, less than 5 % of patients follow a long-term cardiac maintenance program (phase III). Since 2015, our project has been to encourage patients who have completed a phase II cardiac rehabilitation program, to resume regular physical activity in the long term.

La réadaptation cardiovasculaire (RCV) postinfarctus est un programme multidisciplinaire bien défini dont les objectifs sont non seulement d'améliorer la capacité fonctionnelle, la qualité de vie des patients, mais aussi de réduire leur morbi-mortalité cardiovasculaire. Même si la RCV est maintenant fortement recommandée dans les directives internationales pour tous les patients postinfarctus du myocarde, seule la moitié des patients y participe en Suisse. Pire encore, après une RCV de phase II, moins de 5 % des patients à Genève s'inscrivent dans un groupe de maintenance cardiovasculaire (phase III). Nous présentons, dans cet article, les projets que nous menons depuis 2015 afin de stimuler les patients qui ont terminé une RCV de phase II à poursuivre une activité physique régulière et au long cours.

Stairs instead of elevators at workplace: cardioprotective effects of a pragmatic intervention.

BACKGROUND: Population strategies to increase physical activity are an essential part of cardiovascular disease prevention. However, little data exist on lifestyle interventions that are easy to integrate into everyday life such as using stairs instead of elevators at the workplace. DESIGN: Pre and postintervention study. METHODS: A 12-week promotional campaign for stair use consisting in posters and floor stickers at the point of choice between stairs and elevators at each hospital floor was organized in a university hospital building. In 77 selected employees with an inactive lifestyle, physical activity, aerobic fitness, anthropometrics, blood pressure, lipids, insulin sensitivity, and C-reactive protein were assessed at baseline, 12 weeks, and 6 months. RESULTS: During the intervention median daily number of ascended and descended one-story staircase units was 20.6/day (14.2-28.1) compared with 4.5/day (1.8-7.2) at baseline (P<0.001). At 12 weeks, estimated maximal aerobic capacity had increased by 9.2±15.1% (P<0.001) corresponding with approximately 1 MET. There were significant declines in waist circumference (-1.7±2.9%), weight (-0.7±2.6%), fat mass (-1.5±8.4%), diastolic blood pressure (-1.8±8.9%), and low-density lipoprotein cholesterol (-3.0±13.5%). At 6 months, the median daily number of ascended and descended one-story staircase units had decreased to 7.2 (3.5-14.0). Benefits on estimated maximal aerobic capacity (+5.9±12.2%, P=0.001) and fat mass (-1.4±8.4%, P=0.038) persisted. CONCLUSION: Encouraging stair use at work is effective for improving fitness, body composition, blood pressure, and lipid profile in asymptomatic individuals with an inactive lifestyle and thus may be a simple way to significantly reduce cardiovascular disease risk at the population level.

Biatrial anatomical reverse remodelling after radiofrequency catheter ablation for atrial fibrillation: evidence from real-time three-dimensional echocardiography.

AIMS: Reports using two-dimensional echocardiography have indicated that radiofrequency catheter ablation (RFCA) for atrial fibrillation (AF) results in a reduction in the left atrial (LA) size. Furthermore, the effect of pulmonary vein isolation (PVI) on right atrial (RA) anatomical remodelling has not been studied. Three-dimensional echocardiography (3DE) allows us to more precisely quantify atrial volume. Our aim was to assess the effect of PVI on biatrial anatomical remodelling using real-time 3DE. METHODS AND RESULTS: We prospectively studied 91 patients (age 59 +/- 8 years, 79 males) referred for RFCA of paroxysmal (n = 79) or chronic (n = 19) AF. Left atrial and RA volumes were measured using real-time 3DE at baseline and after 6 months of follow-up. Data on AF recurrences were also collected. Left atrial volume was significantly reduced at follow-up when compared with baseline (51 +/- 16 vs. 60 +/- 21 mL, P < 0.001). The same occurred with RA volume (43 +/- 17 vs. 50 +/- 20 mL, P = 0.001). The reduction in the LA volume was more marked in patients with chronic than in those with paroxysmal AF (17 +/- 16 vs. 6 +/- 17 mL, P = 0.017). Patients with AF recurrence (23%) showed similar atrial volume reduction compared with those who were seemingly cured. CONCLUSION: Three-dimensional echocardiography shows evidence of biatrial anatomical reverse remodelling after RFCA for AF. A reduction in the atrial volume occurs despite recurrence of AF.

A predictive score to identify hospitalized patients' risk of discharge to a post-acute care facility.

BACKGROUND: Early identification of patients who need post-acute care (PAC) may improve discharge planning. The purposes of the study were to develop and validate a score predicting discharge to a post-acute care (PAC) facility and to determine its best assessment time. METHODS: We conducted a prospective study including 349 (derivation cohort) and 161 (validation cohort) consecutive patients in a general internal medicine service of a teaching hospital. We developed logistic regression models predicting discharge to a PAC facility, based on patient variables measured on admission (day 1) and on day 3. The value of each model was assessed by its area under the receiver operating characteristics curve (AUC). A simple numerical score was derived from the best model, and was validated in a separate cohort. RESULTS: Prediction of discharge to a PAC facility was as accurate on day 1 (AUC: 0.81) as on day 3 (AUC: 0.82). The day-3 model was more parsimonious, with 5 variables: patient's partner inability to provide home help (4 pts); inability to self-manage drug regimen (4 pts); number of active medical problems on admission (1 pt per problem); dependency in bathing (4 pts) and in transfers from bed to chair (4 pts) on day 3. A score > or = 8 points predicted discharge to a PAC facility with a sensitivity of 87% and a specificity of 63%, and was significantly associated with inappropriate hospital days due to discharge delays. Internal and external validations confirmed these results. CONCLUSION: A simple score computed on the 3rd hospital day predicted discharge to a PAC facility with good accuracy. A score > 8 points should prompt early discharge planning.

Patients' knowledge of drug treatments after hospitalisation: the key role of information.

QUESTION UNDER STUDY: Patients often do not know the reasons for taking their medications after hospital discharge. We investigated whether lack of such knowledge was associated with patients' report of not having received information about their medications while hospitalised. METHODS: Patients with at least one long-term drug (ie, prescribed for more than 30 days) discharged from the wards of general internal medicine of a teaching hospital were included in the study. Patients' knowledge of the reasons for taking these drugs and their report of having received information while hospitalised were assessed by phone one week after discharge. RESULTS: 362 (98.6%) of 367 enrolled patients could be interviewed and provided data on 1693/1871 (90.5%) long-term drugs prescribed at discharge. Patients knew the reasons for taking 1382 (81.6%) drugs and reported having received information about 259 (15.3%) of them. In the adjusted analysis, the reason for taking a drug was less likely to be known when introduced during hospitalisation (OR: 0.7; 95%CI: 0.5 to 0.9), among older patients (OR for > or =80 years of age v/s 20-59: 0.41; 95%CI: 0.22 to 0.76) and among those staying longer (OR per additional hospital day: 0.96; 95%CI: 0.94 to 0.99); such knowledge was strongly and positively associated with the report of having received information during hospitalisation (OR: 7.3; 95%CI: 3.2 to 16.1). CONCLUSION: Patients' report of having received information about their long-term drugs during hospitalisation was associated with a significantly higher knowledge of the reasons for taking them. However, receipt of such information was only infrequently reported.

Age and quality of in-hospital care of patients with heart failure.

BACKGROUND: Elderly patients may be at risk of suboptimal care. Thus, the relationship between age and quality of care for patients hospitalized for heart failure was examined. METHODS: A cross-sectional study based on retrospective chart review was performed among a random sample of patients hospitalized between 1996 and 1998 in the general internal medicine wards, with a principal diagnosis of congestive heart failure, and discharged alive. Explicit criteria of quality of care, grouped into three scores, were used: admission work-up (admission score); evaluation and treatment during the stay (evaluation and treatment score); and readiness for discharge (discharge score). The associations between age and quality of care scores were analysed using linear regression models. RESULTS: Charts of 371 patients were reviewed. Mean age was 75.7 (+/-11.1) years and 52% were men. There was no relationship between age and admission or readiness for discharge scores. The evaluation and treatment score decreased with age: compared with patients less than 70 years old, the score was lower by -2.6% (95% CI: -7.1 to 1.9) for patients aged 70 to 79, by -8.7% (95% CI: -13.0 to -4.3) for patients aged 80 to 89, and by -19.0% (95% CI: -26.6 to -11.5) for patients aged 90 and over. After adjustment for possible confounders, this relationship was not significantly modified. CONCLUSIONS: In patients hospitalized for congestive heart failure, older age was not associated with lower quality of care scores except for evaluation and treatment. Whether this is detrimental to elderly patients remains to be evaluated.