[Impact of a cardiac rehabilitation program on adherence to the mediterranean diet and physical activity in acute coronary syndrome]. / Impacto de un programa de rehabilitación cardiaca en la adherencia a la dieta mediterránea y la actividad física en el síndrome coronario agudo.

Objective: To evaluate the efficacy of a cardiac rehabilitation program (CRP) in improving adherence to non-pharmacological secondary prevention in patients with acute coronary syndrome (ACS). Method: Retrospective study of patients with ACS referred to CRP in a tertiary hospital from 2018 to 2021. Pre-post differences in adherence to physical activity, Mediterranean diet, smoking, and motivation to change were analyzed. Age, sex, and baseline motivation were analyzed in predicting change in adherence. Results: 418 patients were included. At the end of the CRP, the adherence to the mediterranean diet increased (p < 0.05; d = 0.83), frequency of physical activity increased by 2.16 (p < 0.05), and motivation to change remained constant (p = 0.94). Both women and men improved their adherence to the mediterranean diet. Both sexes performed more physical activity at the end of the CRP (1.89 times more in men and 4 times more in women; p < 0.05). An association was found between initial motivation and greater changes in adherence to the mediterranean diet (p < 0.05). An inversely proportional difference was observed between age and adherence to the mediterranean diet (p < 0.05). Conclusions: The CRP, in our hospital environment, has an effect of improving adherence to the mediterranean diet and physical exercise in patients with ACS. The change in adherence to the diet increases as the motivation to change the baseline increases, and age is inversely related to the change in adherence.

Objetivo: Evaluar la eficacia de un programa de rehabilitación cardiaca (PRC) sobre la mejora de la adherencia a las medidas de prevención secundaria no farmacológicas en pacientes con síndrome coronario agudo (SCA). Método: Estudio retrospectivo con pacientes con SCA derivados a PRC en un hospital terciario de 2018 a 2021. Se analizaron diferencias pre-post de adherencia a actividad física, dieta mediterránea, tabaquismo y motivación al cambio. Se analizaron la edad, el sexo y la motivación basal en la predicción del cambio de adherencia. Resultados: Se incluyeron 418 pacientes. Al final del PRC aumentó la adherencia a la dieta mediterránea (p < 0.05; d = 0.83), la frecuencia de actividad física aumentó 2,16 (p < 0.05) y la motivación al cambio se mantuvo constante (p = 0.94). Tanto las mujeres como los hombres mejoraron la adherencia a la dieta mediterránea. Ambos sexos realizaron más ejercicio físico al final del PRC (1.89 veces más los hombres y 4 las mujeres; p < 0.05). Se encontró una asociación entre motivación inicial y mayores cambios en la adherencia a la dieta mediterránea (p < 0.05). Se observó una diferencia inversamente proporcional entre la edad y la adherencia a la dieta mediterránea (p < 0.05). Conclusiones: El PRC, en nuestro medio hospitalario, mejora la adherencia a la dieta mediterránea y al ejercicio físico en los pacientes con SCA. La adherencia a la dieta mediterránea aumenta a medida que lo hace la motivación al cambio basal, mientras que la edad está inversamente relacionada con el cambio de adherencia.

Hybrid cardiac rehabilitation trial (HYCARET): protocol of a randomised, multicentre, non-inferiority trial in South America.

INTRODUCTION: Cardiac rehabilitation (CR) programmes are well established, and their effectiveness and cost-effectiveness are proven. In spite of this, CR remains underused, especially in lower-resource settings such as Latin America. There is an urgent need to create more accessible CR delivery models to reach all patients in need. This trial aims to evaluate if the prevention of recurrent cardiovascular events is not inferior in a hybrid CR programme compared with a standard programme. METHOD AND ANALYSIS: A non-inferiority, pragmatic, multicentre, parallel (1:1), prospective, randomised and open with blinded endpoint assessment clinical trial will be conducted. 308 patients with coronary artery disease will be recruited consecutively. Participants will be randomised to hybrid or standard rehabilitation programme. The hybrid CR programme includes 10 supervised exercise sessions and individualised lifestyle counselling by a physiotherapist, with a transition after 4-6 weeks to unsupervised delivery via text messages and phone calls. The standard CR consists of 18-22 supervised exercise sessions, as well as group education sessions about lifestyle. Intervention in both groups is between 8 and 12 weeks. The primary outcome is a composite of cardiovascular mortality and hospitalisations due to cardiovascular causes. Secondary outcomes are health-related quality of life, exercise capacity, muscle strength, heart-healthy behaviour, return-to-work, cardiovascular risk factor, adherence, and exercise-related adverse events. The outcomes will be measured at the end of intervention, at 6 months and at 12 months follow-up from recruitment. The primary outcome will be tracked through the end of the trial. Per-protocol and intention-to-treat analysis will be undertaken.Cox regression model will be used to compare primary outcome among study groups. ETHICS AND DISSEMINATION: Ethics committees at the sponsor institution and each centre where participants will be recruited approved the study protocol and the Informed Consent. Research findings will be published in peer-reviewed journals; additionally, results will be disseminated among region stakeholders. TRIAL REGISTRATION NUMBER: NCT03881150; Pre-results. DATE AND VERSION: 01 October 2019.

Cost-Effectiveness of Exercise-Based Cardiac Rehabilitation in Chilean Patients Surviving Acute Coronary Syndrome.

PURPOSE: To assess the cost-effectiveness of 3 models of exercise-based cardiac rehabilitation (CR) compared with standard care in survivors of acute coronary syndrome (ACS) within the public health system in Chile. METHODS: A Markov model was designed using 5 health states: ACS survivor, second ACS, complications, general mortality, and cardiovascular mortality. The transition probabilities between health states for standard care and corresponding relative risk for CR were calculated from a systematic review. Health benefits were measured with the EuroQol 5-dimensional 3-level (EQ-5D-3L) survey. Costs for each health state were quantified using the national cost verification study. The CR cost was estimated with a microcosting methodology. The time horizon was a lifetime and the discount rate was 3% per year for costs and benefits. Deterministic and probabilistic analyses were performed. Structural uncertainty was managed by designing 3 scenarios: CR as currently delivered in a specific Chilean public health center, CR as recommended by South American guidelines, and CR as proposed for low-resource settings. RESULTS: Cardiac rehabilitation versus standard care showed an incremental cost-effectiveness ratio for the standard model of $722, for the South American model of $1247, and for the low-resource model of $666. The tornado diagram showed higher uncertainty in relative risk for the complications state and for the second ACS state. CONCLUSION: Considering a cost-effectiveness threshold of 1 unit of gross domestic product per capita (∼$19 000), CR is highly cost-effective for the public health system in Chile.

Perfil do atendimento ao paciente internado com síndrome isquêmica aguda sem supradesnível do segmento ST no Hospital Geral Nossa Senhora da Conceição, Tubarão – SC, 2006-2007 / Clinical Profile of Patients Interned with Acute Coronary syndrome Without ST Segment Elevation in a Hospital in South Brazil – 2006-2007

Objetivo: Descrever as características pessoais, clínicas, de tratamento, evolução para óbito e correlacionar escore TIMI ao número de internaçõesem UTI e transferência para cineangicoronariografia. Métodos: estudo prospectivo transversal empacientes internados no Hospital Nossa Senhora da Conceição em Tubarão-SC, nos períodos de novembro de 2006 a abril de 2007. Resultados: A média foi de idade de 62 anos, com predominância do sexo masculino (61,9%). Da amostrade 42 pacientes, 54,8% apresentou angina instável e 45,2%; infarto agudo do miocárdio sem supra de ST. Osfatores de risco prevalentes foram em ordem decrescente de freqüência: hipertensão arterial (78,6%),hereditariedade (57,1%), tabagismo (52,4%), dislipidemia (50%) e diabetes (38,1%). A angina prévia estava presente em 42,8% dos pacientes, o IAM em 33,3% e arevascularização miocárdica prévia em 7,1%. A maioria dos pacientes apresentou o ECG normal (35,7%) e umescore TIMI de alto, moderado e baixo risco respectivamente em 4,7%, 57,1% e 38%. Os medicamentos usados na emergência em ordem decrescente de freqüência foram: Nitrato (89,7%), AAS(87,2%), oxigênio (48,7%) e morfina (37,8%). E durante a internação os resultados foram: AAS (97,6%),clopidogrel (92,8%), nitrato (87,8%), HBPM (85,7%), IECA (78,5%), betabloqueador (54,7%), estatina (52,8%), bloqueador de cálcio (11,9%) e HNF (9,5%). O escore de TIMI foi referido no prontuário de 1 paciente apenas. Conclusão: O escore TIMI foi pouco registrado nos prontuários. A taxa de mortalidade foi inferior àapresentada pela literatura. Os IECA, estatina, o clopidogrel, a heparina e o AAS durante a internação foram bem utilizados enquanto que o AAS na admissão, o betabloqueador e a estatina podem estar sendo subutilizados. Os pacientes de alto risco pelo escoreTIMI receberam atendimento intensivo na UTI mesmo não havendo significância estatística.

Objective: to describe the personal characteristic, clinical treatment, grown to death and correlate TIMI score to ICU internment or transference to the cardiaccatheterization. Methods: Was made transversal study in intern patients of the Nossa Senhora da Conceição Hospital, between November 2006 to April 2007. Results: The mean rate of age was 62 years old, with predominance of male (61,9%). From the sample 42 patients, 54,8% showed UA and 45,2% NSTEMI. The prevalence of risk factor in decrease attendance order were: arterial hypertension (78,6%), heredity (57,1%), abusive smoking ou tabagysm (52,4%),hyperlipidemia (50%), diabetes (38,1%) The previous angine was present in 42,8% of the patients, the IAM in 33,3% and the previous miocardic revascularization in 7,1%. High, moderate and low TIMI score, respectively in 4,7%, 57,1% and 38%. The medicaments used in emergence in decrease attendance order were: Nitrate(89,7%), SAA (87,2%), Oxygen (48,7%), and Morphine (37,8%), During the internment the results were: SAA (97,6%), clopidogrel (92,8%), nitrate (87,8%), LMWH (85,7%), ACEI (78,5%), â blocker (54,7%), statin(52,8%), calcium blocker (11,9%) and HNF (9,5%). Only one patient had reference to TIMI. Conclusion: The TIMI score was little register in the medical record. The mortality rate was lower than showed in the literature. The use of de ACEI, statin, o clopidogrel, heparin and the SAA during the internmentwere used, however SAA in entrance/admission, the â blocker and a statin can be poor available. The patientswith high risk by means of TIMI score received intensive attendance in the UTI service in spite of no statistic significance.

Circulatory response to a 50-m walk in the coronary care unit in acute coronary syndrome.

BACKGROUND: Lack of a standardized and monitored technique to start rehabilitation of patients with acute coronary syndrome (ACS) in the coronary care unit. OBJECTIVE: To describe the technique of and circulatory response to a 50-m walk (W50m). METHODS: Experimental cross-sectional study of 65 patients with ACS; of these, 36 (54%) with acute myocardial infarction (AMI), Killip I, 29 (45.2%) with unstable angina (UA), 61.5% males with age of 62.8 +/- 12.7 years. Walk was started 45+/-23 h after hospitalization. Parameters measured: systolic blood pressure (SBP mmHg), diastolic blood pressure (DBP mmHg), heart rate (HR bpm), double product (SBP mmHg X HR bpm), peripheral oxygen saturation (SpO2%), walking time, and exercise tolerance by Borg scale (BS). Measurements were taken while supine, sitting, in orthostasis (phase 1 [gravitational stress]), end of the walk, and after a 5-minute rest (phase 2 [exercise stress]). RESULTS: Increased HR in response to the sitting gravitational stress (Delta=4.18) and with orthostasis (Delta=2.69) (p<0.001) was observed. At the end of walk, there was an elevation in SBP (Delta=4.84), (p<0.001), HR (Delta=4.68), (p<0.001) and DP (Delta=344.97), (p=0.004), and a reduction in SpO2 (Delta=-1.42), (p<0.001), with return to baseline values after 5 minutes. Walking time was 2'36''+/-1'17'', and exercise tolerance by BS was good. SBP response >or= 142 mmHg when sitting was associated with a significant increase (p=0.031) of 11 mmHg at exercise in 13 patients with overweight/obesity and 85% with hypertension. Adverse effects occurred in 19 (29.2%) patients and dizziness in 23.1%, which impaired the walk in three of them. CONCLUSION: In this sample, patients did not present severe collateral effects to W50m. 24 hours after a coronary event.

Resposta circulatória à caminhada de 50 m na unidade coronariana, na síndrome coronariana aguda / Respuesta circulatoria a la caminata de 50m en la unidad coronaria, en la síndrome coronaria aguda / Circulatory response to a 50-m walk in the coronary care unit in acute coronary syndrome

FUNDAMENTO: Ausência de técnica padronizada e monitorada para iniciar a reabilitação de pacientes com síndrome coronariana aguda (SCA), na unidade coronariana. OBJETIVO: Descrever a técnica e a resposta circulatória à caminhada de 50 m (C50m). MÉTODOS: Estudo experimental, transversal, com 65 pacientes com SCA; destes 36 (54 por cento) com infarto agudo do miocárdio (IAM), Killip I; 29 (45,2 por cento) com angina instável (AI); 61,5 por cento do sexo masculino, idade 62,8 ± 12,7 anos. Caminhada com início 45 ± 23 horas pós-internamento. Mensuraram-se pressão arterial sistólica (PAS mmHg) e diastólica (PAD mmHg), freqüência cardíaca (FC bpm), duplo produto (PAS mmHg X FC bpm), saturação periférica de oxigênio (SpO2 por cento), tempo de caminhada e percepção do esforço pela escala de Borg (EB). Obtiveram-se medições nas posições supina, sentada e ortostase (fase 1 - estresse gravitacional), no final da caminhada e pós-repouso de 5 minutos (fase 2 - estresse físico). RESULTADOS: Observou-se aumento da FC ao estresse gravitacional sentado (Δ = 4,18) e em ortostase (Δ = 2,69), (p < 0,001). Houve elevação pós-caminhada da PAS (Δ = 4,84), (p < 0,001); FC (Δ = 4,68), (p < 0,001); DP (Δ = 344,97), (p = 0,004); e decréscimo da SpO2 (Δ = -1,42), (p < 0,001), com retorno dos valores basais após 5 minutos. O tempo de caminhada foi de 2'36" ± 1'17". Observou-se boa tolerância ao exercício pela EB. Resposta da PAS > 142 mmHg ao sentar associou-se com aumento significativo (p = 0,031) de 11 mmHg ao exercício em 13 pacientes com sobrepeso/obesidade e 85 por cento com hipertensão. Verificaram-se efeitos adversos em 19 (29,2 por cento) pacientes, tonturas em 23,1 por cento, com impedimento da caminhada em três deles. CONCLUSÃO: Nesta amostra, após 24 horas do evento coronariano, não se verificaram efeitos colaterais graves à C50m.

BACKGROUND: Lack of a standardized and monitored technique to start rehabilitation of patients with acute coronary syndrome (ACS) in the coronary care unit. OBJECTIVE: To describe the technique of and circulatory response to a 50-m walk (W50m). METHODS: Experimental cross-sectional study of 65 patients with ACS; of these, 36 (54 percent) with acute myocardial infarction (AMI), Killip I, 29 (45.2 percent) with unstable angina (UA), 61.5 percent males with age of 62.8 ± 12.7 years. Walk was started 45±23h after hospitalization. Parameters measured: systolic blood pressure (SBP mmHg), diastolic blood pressure (DBP mmHg), heart rate (HR bpm), double product (SBP mmHg X HR bpm), peripheral oxygen saturation (SpO2 percent), walking time, and exercise tolerance by Borg scale (BS). Measurements were taken while supine, sitting, in orthostasis (phase 1 [gravitational stress]), end of the walk, and after a 5-minute rest (phase 2 [exercise stress]). RESULTS: Increased HR in response to the sitting gravitational stress (Δ=4.18) and with orthostasis (Δ=2.69) (p<0.001) was observed. At the end of walk, there was an elevation in SBP (Δ=4.84), (p<0.001), HR (Δ=4.68), (p<0.001) and DP (Δ=344.97), (p=0.004), and a reduction in SpO2 (Δ=-1.42), (p<0.001), with return to baseline values after 5 minutes. Walking time was 2'36"±1'17", and exercise tolerance by BS was good. SBP response > 142 mmHg when sitting was associated with a significant increase (p=0.031) of 11 mmHg at exercise in 13 patients with overweight/obesity and 85 percent with hypertension. Adverse effects occurred in 19 (29.2 percent) patients and dizziness in 23.1 percent, which impaired the walk in three of them. CONCLUSION: In this sample, patients did not present severe collateral effects to W50m. 24 hours after a coronary event.

FUNDAMENTO: Ausencia de técnica estandarizada y de monitoreo para iniciarse la rehabilitación de pacientes con síndrome coronaria aguda (SCA), en la unidad coronaria. OBJETIVO: Describir la técnica y la respuesta circulatoria a la caminata de 50m (C50m)./ MÉTODOS: Estudio experimental, transversal, con 65 pacientes con SCA; el número de 36 (54 por ciento) de ellos con infarto agudo de miocardio (IAM), Killip I; un total de 29 (45,2 por ciento) con angina instable (AI); el 61,5 por ciento del sexo masculino, edad 62,8 ± 12,7 años. Caminata con inicio 45 ± 23 horas post internación. Se calcularon la presión arterial sistólica (PAS mmHg) y diastólica (PAD mmHg), la frecuencia cardiaca (FC bpm), el doble producto (PAS mmHg X FC bpm), la saturación periférica de oxígeno (SpO2 por ciento), el tiempo de caminata y la percepción del esfuerzo a través de la escala de Borg (EB). Se obtuvieron mediciones en las posiciones supina, sentada y ortostasis (fase 1 - estrés gravitacional), al final de la caminata y del post reposo de 5 minutos (fase 2 - estrés físico). RESULTADOS: Se observó un aumento de la frecuencia cardiaca (FC) al estrés gravitacional en la posición sentada (Δ = 4,18) y en ortostasis (Δ = 2,69), (p < 0,001). Hubo elevación post caminata de la PAS (Δ = 4,84), (p < 0,001); FC (Δ = 4,68), (p < 0,001); (DP) (Δ = 344,97), (p = 0,004); y descenso de la SpO2 (Δ = -1,42), (p < 0,001), con retorno de los valores basales tras 5 minutos. El tiempo de caminata fue de 2'36" ± 1'17". Se observó una buena tolerancia al ejercicio mediante la EB. Respuesta de la PAS > 142 mmHg al sentarse se asoció al aumento significativo (p = 0,031) de 11 mmHg al ejercicio en 13 pacientes con sobrepeso/obesidad y el 85 por ciento con hipertensión. Se verificaron efectos adversos en 19 (29,2 por ciento) pacientes, vértigos en el 23,1 por ciento, con interrupción de la caminata en tres de ellos. CONCLUSIÓN: En esta muestra, tras 24 horas ...