Health Disparities in Peripheral Artery Disease: A Scientific Statement From the American Heart Association.

Peripheral artery disease (PAD) affects 200 million individuals worldwide. In the United States, certain demographic groups experience a disproportionately higher prevalence and clinical effect of PAD. The social and clinical effect of PAD includes higher rates of individual disability, depression, minor and major limb amputation along with cardiovascular and cerebrovascular events. The reasons behind the inequitable burden of PAD and inequitable delivery of care are both multifactorial and complex in nature, including systemic and structural inequity that exists within our society. Herein, we present an overview statement of the myriad variables that contribute to PAD disparities and conclude with a summary of potential novel solutions.

Using the RE-AIM framework to evaluate physical activity-based fall prevention interventions in older adults with chronic conditions: A systematic review.

Falls are a serious public health problem, especially for older adults with chronic conditions. The purpose of this systematic review was to evaluate the translational potential of physical activity-based balance interventions for older adults with common chronic conditions guided by the Reach, Effectiveness/Efficacy, Adoption, Implementation, and Maintenance (RE-AIM) framework. Databases were searched (2011-2021) to identify studies with physical activity-based fall prevention interventions for older adults with chronic conditions. Data were collected using the RE-AIM coding guide and Mixed Methods Appraisal Tool for evidence quality. The search yielded 122 articles, of which 14 distinct studies were included. The most reported RE-AIM dimensions across the studies were Reach (46.2%) and Implementation (40.5%), with Effectiveness/Efficacy (29.4%), Adoption (2.0%), and Maintenance (5.4%) being the least reported. Studies were largely conducted in controlled research environments with minimal staff involvement and without long-term follow-up periods. While studies found that physical activity-based programs were effective in improving balance, information on representativeness and adoption/maintenance of programs was lacking. Studies included sufficient details about the intervention (content, dosage, progression). External validity RE-AIM indicators were reported less frequently than internal validity indicators. The studies were of moderate quality overall. Studies often lacked information on indicators critical for understanding how to implement these programs. This review signals the need to investigate the translation of these interventions from controlled research settings to clinical settings to improve the public impact of fall prevention for this population.

Falls are a serious public health problem, especially for older adults with chronic diseases who have a higher risk of falling. For this review paper, we gathered similar research articles that looked at the effects of balance exercise programs in older adults with a variety of chronic diseases and reviewed how likely they could be used in real-world settings using a guide. We found fourteen studies that met our criteria. The most common elements that authors included in their reports were how research subjects were identified and details about the exercise program design/delivery. The least common elements were the scientific outcomes of the program, how/where the program was incorporated, and the long-term effects of the program. While these balance exercise programs for older adults with chronic diseases were successful in these individual research studies, this general area of fall research is somewhat underdeveloped. Researchers should put more consideration into surroundings where these programs could take place and study how these programs could be successful in real-world settings long-term.

Patient-Reported Outcome Measures in Symptomatic, Non-Limb-Threatening Peripheral Artery Disease: A State-of-the-Art Review.

Patient-reported outcome measures (PROMs) are health outcomes directly reported by the patient that can be used to measure the effect of disease and treatments on patient perceived well-being. This review summarizes current evidence regarding the validation of PROMs in people with symptomatic, nonlimb-threatening peripheral artery disease. A literature search was conducted to identify studies of symptomatic peripheral artery disease without limb-threatening ischemia that included PROMs and had sample sizes ≥25. PROMs were summarized along a continuum of validation using classical test theory framework and according to whether they fulfilled defined criteria for (1) content validity; (2) psychometric validation; and (3) further validation evidence base expansion. Of 2198 articles identified, 157 (7.1%) met inclusion criteria. Twenty-four PROMs in patients with symptomatic peripheral artery disease were reviewed. Among disease-specific PROMs, 8 of 15 had excellent reliability as measured by a Cronbach alpha ≥0.80. Based on established criteria for PROM responsiveness, 6 of 15 disease-specific PROMs demonstrated excellent sensitivity to change. Of these, the disease-specific peripheral artery questionnaire, vascular quality of life questionnaire, and walking impairment questionnaire met criteria for validation at each stage of the continuum. For generic (nondisease specific) PROMs, the European Quality of Life 5-Dimension and SF-36 had the most extensive evidence of validation. Evidence from this review can inform selection of PROMs aligned with scientific and clinical goals, given the variable degree of validation and potential complementary nature of the measures.

Development, implementation and participant evaluation of combining text messaging and peer group support in a weight management programme for African-American women.

BACKGROUND: Development of highly accessible interventions that are effective in reducing body weight, preventing weight gain, and maintaining weight loss is urgently needed to solve the current obesity epidemic, especially among African-American women. AIMS: The purpose of this paper is to describe the development, implementation, and participant evaluation processes of a combined text messaging and peer support group programme to enhance weight management skills among African-American women. METHODS: The programme's conceptual framework and operational model were developed to enhance the research design and protocol to support the study rationale and to lay a solid theoretical base for programme implementation. The programme curriculum and schedule were established and embedded into the programme protocol. RESULTS: The 16-week text messaging and peer support group intervention was implemented from September 2014 to March 2015. In total, 2089 messages were sent using an online text messaging application. Eight support group sessions were held in the participant's community centre or community church bi-weekly for approximately one hour. CONCLUSIONS: This paper provides a blueprint of the methodological aspects and insights from participants' evaluation of a combined weight management intervention that can be used or adapted by public health nurses and other community health professionals in their work to develop weight management skills among African-American women.

Cardio-Oncology Rehabilitation to Manage Cardiovascular Outcomes in Cancer Patients and Survivors: A Scientific Statement From the American Heart Association.

Cardiovascular disease is a competing cause of death in patients with cancer with early-stage disease. This elevated cardiovascular disease risk is thought to derive from both the direct effects of cancer therapies and the accumulation of risk factors such as hypertension, weight gain, cigarette smoking, and loss of cardiorespiratory fitness. Effective and viable strategies are needed to mitigate cardiovascular disease risk in this population; a multimodal model such as cardiac rehabilitation may be a potential solution. This statement from the American Heart Association provides an overview of the existing knowledge and rationale for the use of cardiac rehabilitation to provide structured exercise and ancillary services to cancer patients and survivors. This document introduces the concept of cardio-oncology rehabilitation, which includes identification of patients with cancer at high risk for cardiac dysfunction and a description of the cardiac rehabilitation infrastructure needed to address the unique exposures and complications related to cancer care. In this statement, we also discuss the need for future research to fully implement a multimodal model of cardiac rehabilitation for patients with cancer and to determine whether reimbursement of these services is clinically warranted.

Self-Care for the Prevention and Management of Cardiovascular Disease and Stroke: A Scientific Statement for Healthcare Professionals From the American Heart Association.

Self-care is defined as a naturalistic decision-making process addressing both the prevention and management of chronic illness, with core elements of self-care maintenance, self-care monitoring, and self-care management. In this scientific statement, we describe the importance of self-care in the American Heart Association mission and vision of building healthier lives, free of cardiovascular diseases and stroke. The evidence supporting specific self-care behaviors such as diet and exercise, barriers to self-care, and the effectiveness of self-care in improving outcomes is reviewed, as is the evidence supporting various individual, family-based, and community-based approaches to improving self-care. Although there are many nuances to the relationships between self-care and outcomes, there is strong evidence that self-care is effective in achieving the goals of the treatment plan and cannot be ignored. As such, greater emphasis should be placed on self-care in evidence-based guidelines.

Design of the multicenter standardized supervised exercise training intervention for the claudication: exercise vs endoluminal revascularization (CLEVER) study.

The CLaudication: Exercise Vs Endoluminal Revascularization (CLEVER) study is the first randomized, controlled, clinical, multicenter trial that is evaluating a supervised exercise program compared with revascularization procedures to treat claudication. In this report, the methods and dissemination techniques of the supervised exercise training intervention are described. A total of 217 participants are being recruited and randomized to one of three arms: (1) optimal medical care; (2) aortoiliac revascularization with stent; or (3) supervised exercise training. Of the enrolled patients, 84 will receive supervised exercise therapy. Supervised exercise will be administered according to a protocol designed by a central CLEVER exercise training committee based on validated methods previously used in single center randomized control trials. The protocol will be implemented at each site by an exercise committee member using training methods developed and standardized by the exercise training committee. The exercise training committee reviews progress and compliance with the protocol of each participant weekly. In conclusion, a multicenter approach to disseminate the supervised exercise training technique and to evaluate its efficacy, safety and cost-effectiveness for patients with claudication due to peripheral arterial disease (PAD) is being evaluated for the first time in CLEVER. The CLEVER study will further establish the role of supervised exercise training in the treatment of claudication resulting from PAD and provide standardized methods for use of supervised exercise training in future PAD clinical trials as well as in clinical practice.

Poststroke depression and functional outcome: a critical review of literature.

Depression is a frequent complication of stroke with a prevalence of 25% to 79%, depending on the setting, assessment tool, and time poststroke. Patients with poststroke depression (PSD) show far less recovery from functional impairments compared with nondepressed patients with stroke. Many stroke patients have significant physical disability and an inability to carry out activities of daily living. This, in turn, adversely affects quality of life. Poststroke functional disability has been considered predictive of depression after stroke in some literature. However, studies differ on the relative contribution of functional impairment to PSD. The purpose of this article is to synthesize the literature on the relationship between PSD and functional outcome. This synthesis will help identify gaps in knowledge to further direct future studies and provide knowledge for clinicians to improve care and recovery after stroke.

Exercise, quality of life, and symptoms in men and women five to six years after coronary artery bypass graft surgery.

BACKGROUND: Coronary artery bypass graft (CABG) surgery is commonly performed to treat symptoms of heart disease and improve function and quality of life (QL). Health-related behavior including exercise after surgery may promote optimal recovery; however, relationships among exercise behavior, functional status, symptoms, and QL 5 to 6 years after CABG have not been examined in a representative patient sample. METHODS: Telephone interviews and postal surveys were used to examine long-term (5-6 year) recovery after CABG of 163 men and women of the Minnesota participants enrolled in the Post-CABG Biobehavioral Study. RESULTS: Regular exercise and better functional status were related to reports of less shortness of breath and fatigue and better subjective health perception, satisfaction, and QL. RECOMMENDATIONS: Positive relationships between regular exercise and more favorable QL and symptom relief 5 to 6 years after CABG in this observational cohort study warrant prospective study trials to determine the potential long-term benefits of regular exercise after CABG.