Novel advances in cardiac rehabilitation : Position paper from the Working Group on Preventive Cardiology and Cardiac Rehabilitation of the Netherlands Society of Cardiology.

Cardiac rehabilitation (CR) has evolved as an important part of the treatment of patients with cardiovascular disease. However, to date, its full potential is fairly underutilised. This review discusses new developments in CR aimed at improving participation rates and long-term effectiveness in the general cardiac population. It consecutively highlights new or challenging target groups, new delivery modes and new care pathways for CR programmes. These new or challenging target groups include patients with atrial fibrillation, obesity and cardiovascular disease, chronic coronary syndromes, (advanced) chronic heart failure with or without intracardiac devices, women and frail elderly patients. Also, the current evidence regarding cardiac telerehabilitation and loyalty programmes is discussed as new delivery modes for CR. Finally, this paper discusses novel care pathways with the integration of CR in residual risk management and transmural care pathways. These new developments can help to make optimal use of the benefits of CR. Therefore we should seize the opportunities to reshape current CR programmes, broaden their applicability and incorporate them into or combine them with other cardiovascular care programmes/pathways.

Cardiac telerehabilitation as an alternative to centre-based cardiac rehabilitation.

Multidisciplinary cardiac rehabilitation (CR) reduces morbidity and mortality and increases quality of life in cardiac patients. However, CR utilisation rates are low, and targets for secondary prevention of cardiovascular disease are not met in the majority of patients, indicating that secondary prevention programmes such as CR leave room for improvement. Cardiac telerehabilitation (CTR) may resolve several barriers that impede CR utilisation and sustainability of its effects. In CTR, one or more modules of CR are delivered outside the environment of the hospital or CR centre, using monitoring devices and remote communication with patients. Multidisciplinary CTR is a safe and at least equally (cost-)effective alternative to centre-based CR, and is therefore recommended in a recent addendum to the Dutch multidisciplinary CR guidelines. In this article, we describe the background and core components of this addendum on CTR, and discuss its implications for clinical practice and future perspectives.

Peritoneal dialysis in patients with primary cardiac failure complicated by renal failure.

BACKGROUND/AIMS: Clinical outcome in cardiorenal syndrome type II and treated with peritoneal dialysis (PD). METHODS: Retrospective analysis over a period of 10 years. RESULTS: Twenty-four patients with mean age at start of dialysis of 67 ± 10 years had mean survival on dialysis of 1.03 ± 0.84 years (median survival 1.0 year). The number of hospitalizations for cardiovascular causes were reduced (13.7 ± 26.5 predialysis vs. 3.5 ± 8.8 days/patient/month postdialysis, p = 0.001). Patients who survived longer than the median survival time (n = 12) also had a reduced number of hospitalizations for all causes (3.7 ± 3.8 predialysis vs. 1.4 ± 2.1 days/patient/month postdialysis, p = 0.041), a lower age (62 ± 10 vs. 71 ± 8 years, p = 0.013) and fewer had diabetes (2 vs. 7 patients, p = 0.039), but left ventricular ejection fraction was not different. CONCLUSION: After starting PD for cardiorenal syndrome, hospitalizations for cardiovascular causes were reduced for all patients. Survival after starting PD is highly variable. Age and diabetes seem to be significant prognostic factors, but not left ventricular ejection fraction.

Effects of moderate-to-high intensity resistance training in patients with chronic heart failure.

CONTEXT: Resistance training may be beneficial for patients with chronic heart failure (CHF). OBJECTIVE: To systematically review the methodological quality of, and summarise the effects of, moderate-to-high intensity resistance training in CHF. DATA SOURCES: Medline/PubMed, Science Citation Index Expanded, SSCI and A&HCI. STUDY SELECTION: English language (non-)randomised controlled trials. DATA EXTRACTION: A predesigned data extraction form was used to obtain data on trial design and relevant results. Methodological quality of the identified trials were scored using the Delphi list. RESULTS: Most of the 10 trials identified had moderate-to-severe methodological limitations. Effects of resistance training (alone or in combination with endurance training) are inconclusive for outcomes like exercise capacity and disease-specific quality of life. CONCLUSIONS: Even though moderate-to-high intensity resistance training does not seem be harmful for patients with CHF, the current peer-reviewed evidence seems inadequate to generally recommend incorporation of resistance training into exercise-based rehabilitation programmes for patients with CHF.