Sedentary behaviour may cause differences in physical outcomes and activities of daily living in older cardiovascular disease patients participating in phase I cardiac rehabilitation.

This study aimed to investigate the rate of sedentary behaviour and differences in physical outcomes and activities of daily living (ADL) based on sedentary behaviour time of hospitalized older cardiovascular disease patients undergoing phase I cardiac rehabilitation. Older cardiovascular disease patients were enrolled from October 2020 to September 2023 and were divided into the high sedentary behaviour group (≥ 480 min/day) and low sedentary behaviour group (< 480 min/day). Patients' clinical characteristics, usual gait speed, and Five Times Sit to Stand Test time were compared as indices of physical outcomes. Motor, cognitive, and total Functional Independence Measure (FIM) scores were used as indices of ADL and compared between groups using analysis of covariance. Final analysis included 402 patients (mean age: 76.7 years, female: 35.3%). The high sedentary behaviour group included 48.5% of the study patients. After adjustment for baseline characteristics, gait speed (0.80 ± 0.27 vs. 0.96 ± 0.23 m/s, p < 0.001) was lower and FTSST time (11.31 ± 4.19 vs. 9.39 ± 3.11 s, p < 0.001) was higher in the high sedentary behaviour group versus low sedentary behaviour group. Motor (85.82 ± 8.82 vs. 88.09 ± 5.04 points, p < 0.001), cognitive (33.32 ± 2.93 vs. 34.04 ± 2.24 points, p < 0.001), and total FIM scores (119.13 ± 10.66 vs. 122.02 ± 6.30 points, p < 0.001) were significantly lower in the high sedentary behaviour group versus low sedentary behaviour group after adjustment. In older cardiovascular disease patients in phase I cardiac rehabilitation, sedentary behaviour time might influence physical outcomes and ADL at discharge. It is thus important to consider the amount of sedentary behaviour time spent by these patients during daily life while hospitalized.

The efficacy of phase I cardiac rehabilitation training based on augmented reality on the self-efficacy of patients undergoing coronary artery bypass graft surgery: A randomized clinical trial.

BACKGROUND: Open-heart surgery is considered one of the primary treatments for severe coronary artery stenosis, but it comes with its own set of complications. However, these complications can be reduced through the implementation of proper cardiac rehabilitation during phase I. This study aimed to examine the impact of phase I cardiac rehabilitation training, using augmented reality, on the self-efficacy of cardiac management in patients undergoing coronary artery bypass grafting. METHODOLOGY: This randomized clinical trial study involved 60 patients who were admitted to the Cardiac Surgery Intensive Care Unit at Ghaem Hospital in Mashhad. The software used in this study consisted of various videos and educational images demonstrating physical exercises for cardiac rehabilitation. The software was developed to train the patients in the intervention group on the rehabilitation program, starting from their admission to the Intensive Care Unit until their discharge from the hospital. The collected data were analyzed using statistical tests such as independent t-test, Mann-Whitney test, paired t-test, chi-square test, as well as descriptive indicators. Cohen's d was also used to evaluate the magnitude of the effect size. RESULTS: The findings of this study revealed that the total mean score for cardiovascular management self-efficacy significantly increased during the transfer to the Intensive Care Unit and at the time of discharge. Notably, the increase observed in the intervention group was significantly greater than that of the control group (P < 0.001). CONCLUSION: The results of this study indicated that implementing early rehabilitation programs, using innovative educational technology like augmented reality, enhanced the self-efficacy of patients undergoing coronary artery bypass grafting. These findings suggest that such programs can be effectively employed as educational tools throughout different stages of cardiac rehabilitation. TRIAL REGISTRATION: This study was registered in the Iranian Registry of Clinical Trials (no. IRCT20200203046361N1) on 16/02/2020.

Sudden Cardiac Death: A Systematic Review.

Sudden cardiac death (SCD) is a condition that accounts for a high percentage of cardiovascular fatalities, with ventricular tachyarrhythmias being the most common cause. There are signs and symptoms of SCD that occur spontaneously without any warning and are deadly. Despite preventative efforts focusing on the use of subcutaneous implanted cardioverter defibrillators (S-ICD) in the highest-risk population categories, a high number of SCDs occur in the normal population and in people who do not have a documented cardiac condition. Therefore, primary prevention for SCD should be a more viable strategy for the general population, considering measures in the form of preventive medicine such as knowing more about any genetic predisposition, family history of any fatal arrhythmia, continuous surveillance after any syncope with unknown causes, etc. However, little data about SCD risk factors are known in comparison with other well-known diseases like ischemic heart disease and stroke. In search of medical databases for relevant medical literature, we looked at PubMed/Medline, the Cochrane Library, and Google Scholar. Thirteen publications were discovered after the papers were located, assessed, and qualifying criteria were applied. The finished articles were done to give an overview of SCD. Some others have shown that the major predisposition for SCD is related to the male gender, which increases the incidence if they have a family history of SCD. We described the importance of obstructive sleep apnea (OSA) as a comorbid condition. Patients with S-ICD and young athletes with a history of ventricular arrhythmia showed us that the predisposition for SCD can be higher than in the normal population. Based on the above, we concluded that more study is required to establish the most important approach for each of the risk factors mentioned in this systematic review in order to apply them in daily practice and have more knowledge about how to apply preventive and therapeutic medicine to the population at risk and the ones that already develop the disease.

A Systematic Review of Lipid Management in Secondary Prevention and Comparison of International Lipid Management Pathways.

Acute coronary syndrome remains a major cause of morbidity and mortality despite significant improvements in its prevention and management. Lipid management and other risk factors such as hypertension, diabetes, obesity, smoking and sedentary lifestyle stratification is the key to minimising this risk. Lipid management is an important part of secondary prevention and patients are historically undertreated after post-acute coronary syndrome. We performed a narrative review on observational studies on lipid management pathways post ACS on PubMed, Google Scholar, Journal Storage and ScienceDirect and excluded case reports, case series and randomized controlled trials. Our review showed that most patients following acute coronary syndrome receive suboptimal treatment for hypercholesterolemia. The role of statin in reducing future cardiac events risk is undisputable, however, statin intolerance remains a major concern. There is substantial variation in the management of lipids in patients following an acute cardiac event and patients were followed up in primary care in some countries and secondary care in others. The mortality risk is significantly high in patients with second or recurrent cardiac events and future cardiac events are associated with higher morbidity and mortality risk. There is significant variation in lipid management pathways in patients who suffer from cardiac events across the globe and lipid therapy optimization remains suboptimal in these patients, putting them at future risk of cardiovascular events. It is therefore imperative to optimally manage dyslipidemia in these patients in order to minimize the risk of subsequent cardiac events. Cardiac rehabilitation programs might be a way forward to incorporate lipid management for patients discharged from the hospital after having acute coronary events for lipid therapy optimization.

Differential Effects of Cardiac Rehabilitation in Obese and Non-Obese Population.

Background Cardiac rehabilitation (CR) improves outcomes in patients with heart disease. We investigated the differences in outcomes of comprehensive phase II CR in obese and non-obese patients. Methods We performed a retrospective analysis of functional outcomes including metabolic equivalents (METS), heart rate (chronotropic competence - CC), and blood pressure response (BPR) in 178 patients undergoing CR based on underlying body mass index (BMI). Demographic and clinical variables were assessed for age, gender, race, smoking, hypertension, hyperlipidemia, diabetes mellitus, coronary artery disease, stroke, heart failure, medication use, and several sessions attended. Results Initial CC and METS were impaired in majority of patients attending CR, whereas BPR to exercise was mostly preserved. Significant improvement occurred in CC (non-obese: 0.71 ± 0.11 vs 0.76 ± 0.11, p < 0.001; obese: 0.72 ± 0.10 vs 0.75 ± 0.12, p = 0.0010) and METS (non-obese: 4.96 ± 1.98 vs 7.33 ± 2.94, p < 0.001; obese: 4.39 ± 1.81 vs 6.79 ± 3.34, p < 0.001). Post-CR obese patients were able to reach similar level of physical activity as non-obese patients (6.79 ± 3.34 vs 7.33 ± 2.94; p = 0.2). Improvement in BPR was only seen in non-obese patients (24.02 ± 20.07 vs 30.18 ± 21.93; p = 0.019). Improvement in functional variables occurred despite increase in BMI in non-obese (25.91 ± 2.85 vs 26.21 ± 2.96; p = 0.031), and there was no significant change in BMI in obese (35.30 ± 5.60 vs 34.93 ± 5.42; p > 0.05). Conclusion CR concurrently improves functional outcomes in both obese and non-obese patients despite no associated weight loss. The difference in BPR, however, is seen in only non-obese individuals. Future studies are needed to validate the role of weight-optimized CR protocols as a potential target for improving cardiac outcomes.