Physiological and psychological outcomes of high intensity interval training in patients with heart failure compared to moderate continuous training and usual care: A systematic review with meta analysis.

BACKGROUND: An important component of secondary prevention of CVD (including HF) is comprehensive cardiac rehab, including exercise. Novel, individualised approaches are needed to increase uptake and adherence to exercise programmes, one area offering potential is HIIT. HIIT has been shown to be both safe and effective for improving cardiovascular fitness in both coronary artery disease and HF patients. OBJECTIVES: To provide a current and up to date evaluation of the physiological and psychological outcomes of HIIT in patients with HF compared to MCT and UC. Secondly to perform sub-group analyses comparing short and long HIIT protocols. METHODS: A systematic review and meta-analysis of randomised controlled trials was undertaken. Medline, Embase, Scopus, CINAHL and SportDISCUS were searched up to July 2022. Trials were included if they carried out a HIIT intervention (defined at intensity ≥ 80% peak HR or ≥ 80% VO2peak) in HF patients (HFpEF or HFrEF) for at least 6 weeks. Comparator group was UC or MCT. RESULTS: HIIT was shown to be superior to MCT and UC for improving VO2peak (HIIT mean improvement 3.1 mL.kg-1min-1). HITT was superior to MCT and UC for improving LVEF (HIIT mean improvement 5.7%). HIIT was superior to MCT and UC for improving HRQoL, using the MLHFQ (HIIT mean point change of -12.8). Subgroup analysis showed no difference between long and short HIIT. CONCLUSION: HIIT improves VO2peak, LVEF and HRQoL in patients with HF, the improvements seen in VO2peak and LVEF are superior in HIIT compared to MCT and UC.

Clinical and health economic evaluation of a post-stroke arrhythmia monitoring service.

Atrial fibrillation (AF) is a major cause of recurrent stroke and transient ischaemic attack (TIA) in the UK. As many patients can have asymptomatic paroxysmal AF, prolonged arrhythmia monitoring is advised in selected patients following a stroke or TIA. This service evaluation assessed the clinical and potential health economic impact of prolonged arrhythmia monitoring post-stroke using R-TEST monitoring devices. This was a prospective, case-controlled, service evaluation in a single health board in the North of Scotland. Patients were included if they had a recent stroke or TIA, were in sinus rhythm, and did not have another indication for, or contraindication to, oral anticoagulation. A health economic model was developed to estimate the clinical and economic value delivered by the R-TEST monitoring. Approval to use anonymised patient data in this service evaluation was obtained. During the evaluation period, 100 consecutive patients were included. The average age was 70 ± 11 years, 46% were female. Stroke was the presenting complaint in 83% of patients with the other 17% having had a TIA. AF was detected in seven of 83 (8.4%) patients who had had a stroke and one of 17 (5.9%) patients with a TIA. Health economic modelling predicted that adoption of R-TEST monitoring has a high probability of demonstrating both clinical and economic benefits. In conclusion, developing a post-stroke arrhythmia monitoring service using R-TEST devices is feasible, effective at detecting AF, and represents a probable clinical and economic benefit.

Remote monitoring of implantable defibrillators is associated with fewer inappropriate shocks and reduced time to medical assessment in a remote and rural area.

BACKGROUND: Implantable cardioverter defibrillators (ICDs) and cardiac resynchronisation therapy with defibrillators (CRT-D) reduce mortality in certain cardiac patient populations. However, inappropriate shocks pose a problem, having both adverse physical and psychological effects on the patient. The advances in device technology now allow remote monitoring (RM) of devices to replace clinic follow up appointments. This allows real time data to be analysed and actioned and this may improve patient care. AIM: To determine if RM in patients with an ICD is associated with fewer inappropriate shocks and reduced time to medical assessment. METHODS: This was a single centre, retrospective observational study, involving 156 patients implanted with an ICD or CRT-D, followed up for 2 years post implant. Both appropriate and inappropriate shocks were recorded along with cause for inappropriate shocks and time to medical assessment. RESULTS: RM was associated with fewer inappropriate shocks (13.6% clinic vs 3.9% RM; P = 0.030) and a reduced time to medical assessment (15.1 ± 6.8 vs 1.0 ± 0.0 d; P < 0.001). CONCLUSION: RM in patients with an ICD is associated with improved patient outcomes.

External Loop Recorders: Primary Care Placement Is Noninferior to Hospital-Based Cardiac Unit.

Introduction: External loop recorders (ELRs) are recommended for the investigation of syncope and palpitations. This study aimed to compare rates of arrhythmia detection between primary care (PC) and hospital-based cardiac unit (HBCU) fitted ELRs. Methods: Data were captured from January to December 2015. Twenty-eight general practitioner practices and 1 hospital took part. Patients were divided into those with ELR fitted in PC or HBCU. All ELR data were analyzed by a cardiac physiologist. Results: A total of 560 ELR recordings were analyzed; 219 (PC) versus 341 (HBCU). There was no difference between the baseline characteristics (all Ps > .05). The predominant indication for ELR in each group were palpitations; between-group variation was observed for syncope (P = .0004). There were no significant between-group differences in the number of recordings per patient; however, PC group wore the ELR for less time (median 7 days vs median 14 days; P < .0001). There were no differences in arrhythmia detection between PC- and HBCU-fitted ELRs (16.2% [n = 39] vs 21.7% [n = 74], respectively; P = .28). PC placement of ELRs was highest in very remote rural communities (P = .005) and correlated with distance from HBCU (r = 0.39; P = .04). Conclusions: This study showed no difference in detection of arrhythmias between PC and HBCU fitted ELRs. This suggests adequate ELR recording can be completed by suitably trained staff in PC. Furthermore, ELRs were fitted for less time in PC without an adverse effect on diagnostic yield. ELR usage increased with increasing distance from the specialist center and rurality suggesting improved local access to arrhythmia detection services.