Cardiac rehabilitation: interventions and outcomes 629

Cardiac rehabilitation: interventions and outcomes
629
netic terms, HNF4A CC genotype (OR=1.50; p=0.006) and PCSK9 GG variant
(OR=1.30; p=0.047) showed significant increased risk for onset of complication.
After logistic regression the two genetic variants remained in the equation: HNF4A
CC (OR=3.90; p=0.031) and PCSK9 GG (OR=1.95; p=0.017) with sedentary life
(OR=1.71; p<0.0001).
Conclusion: According to these results, there are risk factors such as sedentary
life and some genetic variants (HNF4A and PCSK9) that are significantly and independently associated with MACE occurrence and allow us to predict vascular
complications after CAD diagnosis. If patients have one or more of these conditions, a particularly careful secondary prevention should be ensured.
P3359 | BEDSIDE
Differential impact of a nurse-led, home-based intervention for
optimal secondary cardiac prevention on recurrent hospitalization
in men and women: the Young @ Heart multicentre, randomized
trial
S. Stewart 1 , M.J. Carrington 1 , S. Goldstein 2 , P. Scuffham 3 . 1 Baker IDI Heart
and Diabetes Institute, Melbourne, Australia; 2 University of New South Wales,
Sydney, Australia; 3 Griffith University, Brisbane, Australia
P3360 | BENCH
Sodium bicarbonate versus isotonic saline for the prevention of
contrast induced nephropathy in patients with diabetes mellitus
undergoing coronary angiography and/or intervention: a
multicenter study
M.G. Kaya 1 , F. Koc 2 , F. Altunkas 2 , A. Celik 2 , M. Akpek 1 . 1 Erciyes University
School of Medicine, Department of Cardiology, Kayseri, Turkey; 2 Gaziosmanpasa
University, Faculty of Medicine, Department of Cardiology, Tokat, Turkey
Objectives: Contrast induced nephropathy (CIN) is a leading cause of acute renal failure and affects mortality and morbidity. Although CIN incidence is quite
low in the general population, the incidence of CIN is significantly increased in
diabetes mellitus (DM). We compared the efficacy of prophylactic use consisting
of a saline infusion or a sodium bicarbonate infusion for the prevention of CIN in
patients with DM.
Methods: A total of 195 DM patients, who had unselected renal function, were
randomized into 2 groups: 101 patients were assigned to saline infusion and 94
patients were assigned patients to bicarbonate infusion. The primary end point
was the maximum increase in the serum creatinine (SCr) level. The secondary
end point was the development of CIN after the procedure.
Results: The maximum increase in SCr levels was significantly lower in the saline
group than in the bicarbonate group, -0.03 [IQR = -0.09 to 0.10] mg/dL vs. 0.02
[IQR = -0.09 to 0.13] mg/dL (P=0.014) (Figure). The rate of CIN was significantly
lower in the saline group than in the bicarbonate group (5.9% vs. 16%, P=0.024).
In the subset of study participants with a baseline creatinine clearance of <60
mL/min, the maximum increase in SCr levels was significantly lower -0.08 [IQR =
-0.13 to -0.04] mg/dL in the saline group than in the bicarbonate group 0.03 [IQR
= -0.13 to 0.12] mg/dL (P=0.004).
Conclusions: The use of prophylactic hydration with isotonic saline before coronary procedures may decrease SCr levels and reduce the incidence of CIN in DM
patients with unselected renal functions to a greater extent than sodium bicarbonate
P3361 | BEDSIDE
Motivational interviewing as educational program in improving
cardiac risk factors control in patients post myocardial infarction
S.M. Soliman, G. Selim. Ain Shams University, cairo, Egypt
Introduction: Motivational interviewing (MI) is a counseling style that was developed as an alternative to more traditional counseling using direct persuasion. It
uses the patient’s responses to reinforce talk directed toward change. The study
examines MI as a tool for promoting lifestyle change in patients post infarction
particularly smoking cessation, decrease saturated fat intake and increase physical activity.
Methods: 1850 post myocardial infarction patients were recruited over 2 years
period and were randomly assigned to either usual follow up or MI educational
program. Patients participated in a 30 min weekly education session for eight
weeks. Follow up telephone calls after another 4 weeks.
Results: After MI, 95% of patients reported self cessation of smoking versus
75% in usual care patients (p<0.05). Awareness as regards overweight was increased, and 45% took active steps to reduce their weight versus 12% in usual
care (p<0.05). Awareness to diet modifications has improved and 88% took active steps to reduce saturated fat versus 43% in usual care (p<0.05). After MI,
56% took active steps to increase their physical activity versus 32% in usual care
(p<0.05).
Conclusion: MI can promote behavior change in patients post infarction and is
advisable to integrate in rehabilitation program.
P3362 | BEDSIDE
Preoperative levels of pro-inflammatory mediators predict the
development of acute heart failure and the need for inotropic
support after elective coronary artery bypass surgery
M. Demosthenous 1 , C. Antoniades 1 , A.S. Antonopoulos 1 , D. Tousoulis 1 ,
A. Miliou 1 , N. Koumallos 1 , C. Psarros 2 , C. Bakogiannis 1 , C. Triantafillou 3 ,
C. Stefanadis 1 . 1 Hippokration Hospital, University of Athens, 1st Department
of Cardiology, Athens, Greece; 2 University of Athens Medical School, Athens,
Greece; 3 Hippokration Hospital, 1st Department of Cardiac Surgery, Athens,
Greece
Background: Coronary bypass grafting (CABG) operation frequently requires
prolonged hospitalization, due to complications that include acute left ventricular (LV) failure. It is therefore essential to identify the key mechanisms trigering
LV failure post-CABG, and identify novel therapeutic targets. Further to the role
of interleukin 6 (IL-6) and high sensitivity C-reactive protein (hsCRP) in inflammatory resposnes post CABG, monocyte chemoattractand protein-1 (MCP-1) has a
role in immune cell chemotaxis and regulates cell infiltration to the myocardium.
We examined the predictive role of preoperative MCP-1, IL-6 and hsCRP for the
development of acute heart failure after CABG.
Methods: We recruited 248 patients undergoing elective CABG. LV systolic function was evaluated preoperatively. The morning before surgery, blood samples
were obtained and the levels of MCP-1, IL-6 and CRP were determined by ELISA.
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Background: We examined the impact of a two year secondary prevention program on recurrent hospitalization in cardiac patients with ready access to specialist care.
Methods: The Young at Heart Study was a multicentre, randomized controlled
trial comparing usual post-discharge care (UC) with a flexible, nurse-led, homebased intervention (HBI). The primary endpoint was rate of all-cause hospital stay
during 31.5±7.5 months follow-up.
Results: Overall, 602 (mean age 70±10 years, 72% men and 62% hospitalized for coronary artery disease of whom 39% underwent coronary revascularization) patients were randomized to UC (n=296) or HBI (n=306 - 96% received
at least one home visit). Women were on average 5 years older (p<0.001) and
had greater levels of co-morbidity (p=0.009) than men; these differences were
consistent across the two study groups. At 2 years, more HBI versus UC (39 vs.
27%; OR 1.67; 95% CI 1.15 – 2.41; p=0.007) patients were assessed as stable
and optimally managed. Overall, 42 patients (7.0%) died and 492 patients (82%)
were hospitalized with 2338 all-cause admissions and 10,045 days of hospitalization. There were no group differences (HBI vs. UC) in the primary endpoint
of all-cause hospital stay (0.78±2.01 vs. 0.68±1.96/month; p=0.546) or all-cause
hospitalization (0.14±0.20 vs. 0.14±0.30/month; p=0.867). Overall, men in the
HBI group (40/215 [19%]) were significantly less likely to experience a cardiovascular admission compared to UC (61/216 [28%]) with the reverse situation
for women in the HBI group (30/91 [33%]) vs. UC (20/80 [25%]). Independent
correlates of cardiovascular admission were living alone (HR 1.62, 95% CI 1.032.54; p=0.038) and increasing comorbidity (HR 1.09, 95% CI 1.02 – 1.16 per unit
score; p=0.013) for men and women combined. For men only, assignment to the
HBI group (HR 0.61, 95% CI 0.41-0.93 for HBI vs. UC; p=0.019) and advancing
age was associated with reduced likelihood of a cardiovascular readmission (HR
0.97, 95% CI 0.94-1.00 per year; p=0.05) with 583 less days of (p=0.036) hospital
stay. In women, advancing age (HR 1.06, 95% CI 1.01-1.10 per year; p=0.012)
and study site (HR 0.57, 95% CI 0.40-0.82, site A vs. B; p=0.002) were the only
significant correlates, with assignment to HBI associated with a non-significant
1.4-fold increased risk of such an event.
Conclusions: Despite high levels of engagement and potential clinical improvements at 2 years, HBI did not reduce levels of recurrent hospital stay compared to
usual care. However, improved cardiovascular outcomes in men, but not women,
requires further investigation.
Figure 1
630
Cardiac rehabilitation: interventions and outcomes
The patients were followed-up until their discharge from the hospital. The development of acute heart failure and the use of inotropes were recorded.
Results: High preoperative levels of MCP-1 (A), IL-6 (B) and hsCRP (C) are more
likely to require inotropic support post-CABG. Moreover, in multiple regression
analysis, MCP-1 and IL-6 were predictors of the use of inotropes in the postoperative period (P<0.05 for both), independently of risk profile and preoperative
LV systolic function.
Conclusions: Preoperative levels of MCP-1, IL-6 and hsCRP are independent
predictors of the need of post-operative inotropic support independently of preoperative LV systolic function in patients undergoing CABG. Our data identify
these pro-inflammatory biomarkers as potential therapeutic targets for the improvement of post-operative recovery after CABG surgery.
activities of daily living-8 (PMADL-8) 2 weeks after discharge. The PMADL-8 was
used to assess the difficulty in performing specified daily physical activities. To
evaluate limiting factors for the ADL, the stepwise multiple regression analysis
was performed using indices of respiratory and motor function as predictive variables.
Results: The PMADL-8 showed significant univariate correlations to age
(r=0.376), FVC (r=-0.507), forced expiratory volume in 1 second (r=-0.495),
maximal inspiratory pressure (r=-0.365), maximal expiratory pressure (r=-0.364),
quadriceps strength (r=-0.410), one leg standing time (r=-0.341) and 10-meter
walking speed (r=-0.581) (p<0.001, respectively). The result of the stepwise multiple regression analysis was shown in Table. The FVC and one leg standing
time were detected as significant and independent predictors for the decreased
ADL.
P3363 | BEDSIDE
Number of cardiac and noncardiac comorbidities predict sexual
concerns
Result of multiple regression analysis
1
1
1
2
2
1
E. Steinke , V. Mosack , T.J. Hill , C. Walker , M. Medina . Wichita State
University, Wichita, United States of America; 2 Via Christi Health, Wichita, United
States of America
Predictors of Sexual Concerns
Predictors
(constant)
Race
Ever smoked
BMI
Number cardiac comorbidities
Number non-cardiac comorbidities
Number different sexual activities
Adjusted R2=0.213**
Unstandardized
coefficients
Beta
Std. Error
−2.170
1.667
1.303
0.109
0.969
1.513
0.400
2.320
1.663
0.941
0.073
0.273
0.388
0.210
Standardized
coefficients
Beta
t
0.068
0.090
0.100
0.235
0.226
0.123
−0.935
1.003
1.385
1.487
3.550***
3.903***
1.907*
OLS Regression Analysis: *p=0.058, **p<0.001, ***p<0.0001.
Conclusions: Comorbidities, sexual activities, and demographic factors contributed to sexual concerns, fears, symptoms, and dysfunction. Thorough sexual
assessment by providers is critical to understand individual concerns and to tailor
sexual counseling.
P3364 | BEDSIDE
Forced vital capacity is an independent determinant for decreased
activities of daily living in patients with chronic heart failure
N. Hamazaki 1 , K. Kamiya 1 , K. Miida 1 , K. Hotta 2 , R. Shimizu 2 , D. Kamekawa 2 ,
A. Akiyama 2 , S. Tanaka 2 , C. Noda 3 , T. Masuda 4 . 1 Cardiac Rehabilitation
Room, Kitasato University Hospital, Sagamihara, Japan; 2 Kitasato University
Graduate School of Medical Sciences, Sagamihara, Japan; 3 Department of
Cardio-angiology, Kitasato University School of Medicine, Sagamihara, Japan;
4 Department of Rehabilitation, School of Allied Health Sciences, Kitasato
University, Sagamihara, Japan
Purpose: Exercise tolerance is well known to be a limiting factor for activities of
daily living (ADL) in patients with chronic heart failure (CHF). Although many studies documented the relationship between forced vital capacity (FVC) and cardiovascular events, it is not evaluated the relationship between respiratory function
and ADL in them. The purpose of this study was to investigate whether respiratory
function is a limiting factor for the ADL in CHF patients.
Methods: We studied 269 patients (194 males) with compensated CHF aged
64.3±14.1 years who underwent a cardiac rehabilitation during the hospitalization. The patients who received a cardiac surgery or had chronic respiratory disease were excluded. We measured pulmonary function, muscle strength and one
leg standing time at the hospital discharge. The ADL was evaluated using 10meter comfortable walking speed at discharge and the performance measure for
Forced vital capacity
One leg standing time
R2
10-meter walking speed
B
β
p value
8.323
0.203
0.543
0.267
0.396
<0.001
0.012
B
−2.566
−0.083
PMADL-8
β
−0.466
−0.308
0.332
p value
<0.001
0.006
PMADL-8, performance measure for activities of daily living-8.
Conclusion: The FVC was identified as an independent strong determinant for
decreased ADL in patients with CHF.
P3365 | BENCH
Characteristic and outcome in patients with st-evaluation
myocardial infarction an out-of hospital reanimation insight from
the national amis plus registry 1997-2011
M. Maggiorini 1 , A. Mueller 1 , D. Radovanovic 1 , P. Erne 2 . 1 University Hospital
Zurich, Intensive Care Medicine, Zurich, Switzerland; 2 Lucerne Cantonal
Hospital, Lucerne, Switzerland
Background: Cardiac arrest is one of the most life-threatening complications
of ST-Elevation Myocardial Infarction (STEMI). Aim of the study was to identify
potential treatable factors jeopardizing the outcome out of hospital resuscitated
STEMI patients.
Methods: All acute STEMI enrolled in the AMIS PLUS registry between January 1, 1997 and December 31, 2011 were analyzed. Patients were divided into
those who had experienced Out-of Hospital Cardiac Arrest (OHCA) and those
who did not. OHCA was defined as cardiac arrest requiring resuscitation procedures (chest compression, defibrillation, cardioversion), as defined by the European Resuscitation Council. Successful resuscitation was required in order to be
included in this study. The primary outcome was in-hospital mortality. Secondary
outcome measures were the rates of in-hospital major adverse cardiac or cerebrovascular events.
Results: Between 1997 and 2011, a total of 21,401 patients with STEMI were
included in the AMISplus registry. 939 of 20,773 patients (4.5%) with complete
data sets had OHCA. There mortality was 31.1% vs. 6.7% (p<0.001). STEMI
patients with OHCA were younger, more often males and smokers. The extension of coronary artery disease and comorbidities were similar between groups.
More patients with OHCA were in cardiogenic shock and needed catecholamines
and/or mechanical ventilation. In hospital CPR was more frequently in OHCA
patients. A primary PCI was performed in 55.9% controls and 57.6% OHCA patients (p = 0.31). At hospital discharge less patients with OHCA received aspirin,
statins, beta blockers and ACE Inhibitors/AT Antagonists. Since 2009 therapeutic
hypothermia was recorded and performed in 55 (46%) out of 119 OHCA patients.
In the logistic regression analyses, the OR for mortality for patients who had CPR
prior to admission was, unadjusted, 6.3 (95% CI 5.4 to 7.32; p<0.001); and adjusted for age and gender it was 10.18 ((95% CI 8.6 to 12.04; p<0.001).
Conclusion: The mortality of STEMI patients with out-of-hospital cardiac arrest is
high. Appropriate management of cardiogenic shock and therapeutic hypothermia
are key to reduce mortality in these patients.
P3366 | BEDSIDE
High intensity, interval exercise improves diastolic function and
ergometric capacity of patients with chronic heart failure: a phase
III randomized clinical trial
C. Chrysohoou, G. Tsitsinakis, A. Aggelis, E. Herouvim, D. Tsiachris, J. Vogiatzis,
A. Tsantilas, C. Pitsavos, N. Koulouris, C. Stefanadis. University of Athens,
Athens, Greece
Background: The aim of this work was to evaluate the effect of high intensity, interval exercise on echocardiographic markers of systolic and diastolic ventricular
function among chronic heart failure (CHF) patients.
Methods: A phase III clinical trial. Of the 100 consecutive CHF patients (NYHA
class II-IV, ejection fraction<30%) that were randomly allocated to exercise treatment (n=50) or control (n=50), 72 (exercise group, n=33, 63±9 years, 88% men,
70% ischemic heart failure and exercise group, n=39, 56±11 years, 82% men,
70% ischemic heart failure) completed the study. Particularly, the intervention
group followed a high intensity, interval ergometric aerobic training (i.e., 30 sec
at 100% of max workload, 30 sec at rest) for 30 min/day-by-12 weeks, whereas
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Purpose: Cardiac patients frequently report sexual concerns after an acute or
chronic cardiac problem. While sexual problems have been generally reported,
our study examined demographic variables, co-morbid conditions, and sexual activities as predictive factors of sexual concerns.
Methods: Descriptive, cross-sectional survey of patients with CAD, ACS, angina,
MI, HF, or CABG. Participants (N=205) responded to demographic questions, a
Sexual Concerns Inventory (12 items rated "never" to "frequently", with 3 subscales). Two items on ED were analyzed as one item to measure patient or male
partner’s ED; thus, concerns were scored with 11 items (R=0-33). Participants
chose from 20 cardiac/noncardiac co-morbidities. Sexual activity score was an
index of whether or not the respondents participated in 8 possible activities ranging from kissing/hugging to intercourse. Data were analyzed using t-tests, correlations, and OLS regression.
Results: Non-Whites, those not employed, and those who smoked had significantly more sexual concerns; men and those not employed reported more sexual
dysfunction, non-Whites reported more fears and symptoms, and smokers reported more symptoms and sexual dysfunction. The number of cardiac and noncardiac comorbidities significantly predicted sexual concerns (R2=0.213; Table).
For those sexually active, specific sexual activities yielded significantly greater
concerns.
Variables