scholarly journals The Canadian Cardiac Rehabilitation Registry: Inaugural Report on the Status of Cardiac Rehabilitation in Canada

2015 ◽  
Vol 2015 ◽  
pp. 1-6 ◽  
Author(s):  
Sherry L. Grace ◽  
Trisha L. Parsons ◽  
Kristal Heise ◽  
Simon L. Bacon
Keyword(s):  
Cardiac Rehabilitation ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Wait Time ◽  
Coronary Intervention ◽  
Discharge Data ◽  
Beneficial Effects ◽  
Coronary Syndrome ◽  
The Status ◽  
The Impact

Introduction. There are over 200 Cardiovascular Rehabilitation (CR) programs in Canada, providing services to more than 50,000 new patients annually. The objective of this study was to describe the impact of CR in Canada.Methods. A retrospective analysis of Canadian CR Registry data is presented. There were 12 programs participating, with 4546 CR participants.Results. The average wait time between patient referral and CR admission was 68 ± 64 days. Participants were 66.3 ± 11.5 years old, 71% male, and 82% White. The three leading referral events were coronary artery bypass graft surgery, percutaneous coronary intervention, and acute coronary syndrome. At discharge, data were available for ~90% of participants. Significant improvements in blood pressure (systolic pre-CR 123.5 ± 17.0, post-CR 121.5 ± 15.8 mmHg;p<.001), lipids, adiposity, and exercise capacity (peak METs pre-CR 6.5 ± 2.8, post-CR 7.2 ± 3.1;p<.001) were observed. However, target attainment for some risk factors was suboptimal.Conclusions. This report provides the first snapshot of the beneficial effects of CR in Canada. Not all patients are equally represented in these programs, however, leaving room for more referral of diverse patients. Greater attainment of risk reduction targets should be pursued.

scholarly journals Mortality and Revascularization among Myocardial Infarction Patients with Schizophrenia: A Population-Based Cohort Study

2020 ◽  
Vol 65 (7) ◽  
pp. 454-462 ◽  
Author(s):  
Tanya S. Hauck ◽  
Ning Liu ◽  
Harindra C. Wijeysundera ◽  
Paul Kurdyak
Keyword(s):  
Myocardial Infarction ◽  
Coronary Revascularization ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Coronary Intervention ◽  
Population Based ◽  
Geographic Region ◽  
Time Varying ◽  
The Impact ◽  
The Relationship

Background: Cardiovascular disease is a major source of mortality in schizophrenia, and access to care after acute myocardial infarction (AMI) is poor for these patients. Aims: To understand the relationship between schizophrenia and access to coronary revascularization and the impact of revascularization on mortality among individuals with schizophrenia and AMI. Method: This study used a retrospective cohort of AMI in Ontario between 2008 and 2015. The exposure was a diagnosis of schizophrenia, and patients were followed 1 year after AMI discharge. The primary outcome was all-cause mortality within 1 year. Secondary outcomes were cardiac catheterization and revascularization (percutaneous coronary intervention or coronary artery bypass graft). Cox proportional hazard regression models were used to study the relationship between schizophrenia and mortality, and the time-varying effect of revascularization. Results: A total of 108,610 cases of incident AMI were identified, among whom 1,145 (1.1%) had schizophrenia. Schizophrenia patients had increased mortality, with a hazard ratio (HR) of 1.55 (95% CI, 1.37 to 1.77) when adjusted for age, sex, income, rurality, geographic region, and comorbidity. After adjusting for time-varying revascularization, the HR reduced to 1.38 (95% CI, 1.20 to 1.58). The impact of revascularization on mortality was similar among those with and without schizophrenia (HR: 0.42; 95% CI, 0.41 to 0.44 vs. HR: 0.40; 95% CI, 0.26 to 0.61). Conclusions: In this sample of AMI, mortality in schizophrenia is increased, and treatment with revascularization reduces the HR of schizophrenia. The higher mortality rate yet similar survival benefit of revascularization among individuals with schizophrenia relative to those without suggests that increasing access to revascularization may reduce the elevated mortality observed in individuals with schizophrenia.

Coronary artery bypass graft surgery

2017 ◽  
Author(s):  
Piroze M Davierwala ◽  
Friedrich W Mohr
Keyword(s):  
Acute Coronary Syndrome ◽  
Coronary Artery ◽  
Coronary Artery Bypass Graft ◽  
Coronary Artery Bypass ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Coronary Intervention ◽  
Artery Bypass Graft ◽  
Coronary Syndrome ◽  
Percutaneous Coronary

The surgical management of acute coronary syndrome still remains a challenge for the cardiac surgeon. Although most patients can be managed by percutaneous coronary intervention, for patients with complex multivessel or left main coronary artery disease (high SYNTAX score), in whom percutaneous coronary intervention is not possible or is unsuccessful, urgent or emergent coronary artery bypass graft surgery is the only available option. It is very important for surgeons to determine the optimum timing of surgical intervention, which is usually based on the clinical presentation, coronary anatomy, and biomarkers. Surgeons should be conversant with the different operative techniques, whether off- or on-pump coronary artery bypass graft surgery, that would help in achieving the best possible outcomes in such situations. Early and late survival of patients depends not only on an efficiently executed operation, but also on the competency of the post-operative care delivered. Modern perioperative management is reinforced by the availability of a variety of mechanical cardiopulmonary assist devices, like the intra-aortic balloon pump, the extracorporeal membrane oxygenation, and an array of ventricular assist devices, which aid us in managing very sick patients presenting with cardiogenic shock. The results of coronary artery bypass graft surgery for acute coronary syndrome, as published in the literature, vary significantly, because of the heterogeneity of patient populations, operative timing, and haemodynamic status, making a comparison of surgical outcomes almost impossible. Only one randomized trial has been conducted to that effect, to date. A heart team approach, involving an interventional cardiologist and a cardiac surgeon, is mandatory to determine the best treatment strategy and achieve the best possible outcomes in patients with acute coronary syndrome.

scholarly journals Cardiac rehabilitation after percutaneous coronary intervention: Results from a nationwide survey

2017 ◽  
Vol 17 (3) ◽  
pp. 273-279 ◽  
Author(s):  
Siv JS Olsen ◽  
Henrik Schirmer ◽  
Kaare H Bønaa ◽  
Tove A Hanssen
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Confidence Interval ◽  
Cardiac Rehabilitation ◽  
Odds Ratio ◽  
Bypass Graft ◽  
Participation Rate ◽  
Coronary Intervention ◽  
Lower Probability ◽  
Coronary Syndrome ◽  
Percutaneous Coronary

Aim: The purpose of this study was to estimate the proportion of Norwegian coronary heart disease patients participating in cardiac rehabilitation programmes after percutaneous coronary intervention, and to determine predictors of cardiac rehabilitation participation. Methods: Participants were patients enrolled in the Norwegian Coronary Stent Trial. We assessed cardiac rehabilitation participation in 9013 of these patients who had undergone their first percutaneous coronary intervention during 2008–2011. Of these, 7068 patients (82%) completed a self-administered questionnaire on cardiac rehabilitation participation within three years after their percutaneous coronary intervention. Results: Twenty-eight per cent of the participants reported engaging in cardiac rehabilitation. Participation rate differed among the four regional health authorities in Norway, varying from 20%–31%. Patients undergoing percutaneous coronary intervention for an acute coronary syndrome were more likely to participate in cardiac rehabilitation than patients with stable angina (odds ratio 3.2; 95% confidence interval 2.74–3.76). A multivariate statistical model revealed that men had a 28% lower probability ( p<0.001) of participating in cardiac rehabilitation, and the odds of attending cardiac rehabilitation decreased with increasing age ( p<0.001). Contributors to higher odds of cardiac rehabilitation participation were educational level >12 years (odds ratio 1.50; 95% confidence interval 1.32–1.71) and body mass index>25 (odds ratio 1.19; 95% confidence interval 1.05–1.36). Prior coronary artery bypass graft was associated with lower odds of cardiac rehabilitation participation (odds ratio 0.47; 95% confidence interval 0.32–0.70) Conclusion: The estimated cardiac rehabilitation participation rate among patients undergoing first-time percutaneous coronary intervention is low in Norway. The typical participant is young, overweight, well-educated, and had an acute coronary event. These results varied by geographical region.

scholarly journals The Impact of Cardiac Rehabilitation on the Level of Anxiety and Symptoms of Depression in Patients after Coronary Revascularization

2021 ◽  
Vol 75 (1) ◽  
pp. 939-946
Author(s):  
Adam Rafał Poliwczak ◽  
Karolina Jędrzejczak-Pospiech ◽  
Bogumiła Polak ◽  
Jan Błaszczyk ◽  
Robert Irzmański
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass Graft ◽  
Cardiac Rehabilitation ◽  
Coronary Artery Bypass ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Depression Symptoms ◽  
Artery Bypass Graft ◽  
Symptoms Of Depression ◽  
The Impact

Abstract Introduction The coexistence of depression and anxiety disorder significantly worsens the results of treatment and increases the risk of recurrent cardiovascular incidents. The aim of the study was to assess the impact of cardiac rehabilitation on anxiety and depression symptoms in patients after interventional cardiology or coronary artery bypass graft (CABG). Material and Methods The study enrolled 40 participants aged 70.75±7.38 years, treated interventionally for ACS or undergoing urgent coronary artery bypass graft (CABG). Patients participated in 3-week stationary early cardiac rehabilitation. At the beginning and end of the study, the Beck Depression Inventory (BDI) and Spielberger’s State-Trait Anxiety Inventory (STAI) were performed. Results 92.5% of subjects had at least one comorbidity, mostly hypertension (67.5%) and heart failure (60.0%). At the beginning the BDI level was 14.55±6.47; depression symptoms were present in 65% of subjects. At the end, BDI decreased significantly to 8.28±5.26; p<0.001. BDI was statistically significantly higher at the beginning and end in women than in men (17.94±7.07 vs. 11.78±4.40; p<0.05 and 10.56±5.90 vs. 6.41±3.88; p<0.01). Persons before rehabilitation were characterized by medium and low levels of STAI-X1 anxiety (31.80±7.24 and STAI-X2: 35.98±8.29). Finally, anxiety decreased statistically significantly to 26.40±6.30 and 29.80±6.57; p<0.001. At the beginning and end, it strongly correlated positively with the severity of depressive symptoms (STAI-X1 R=0.76; p<0.001, STAI-X2 R=0.70; p<0.001 and R=0.76; p<0.001, R=0.70; p<0.001). Conclusions Cardiac rehabilitation contributes significantly to reducing anxiety levels and reducing symptoms of depression. Implementation of these interventions as soon as possible brings the best results, contributing to reducing the risk of coronary events.

scholarly journals Do Patients Maintain Proper Long-Term Cardiopulmonary Fitness Levels After Cardiac Rehabilitation? A Retrospective Study Using Medical Records

2021 ◽  
Vol 45 (2) ◽  
pp. 150-159
Author(s):  
Chul Kim ◽  
Hee Eun Choi ◽  
Jin Hyuk Jang ◽  
Jun Hyeong Song ◽  
Byung-Ok Kim
Keyword(s):  
Retrospective Study ◽  
Exercise Training ◽  
Cardiac Rehabilitation ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Hospital Setting ◽  
Aerobic Exercise Training ◽  
Cardiopulmonary Fitness ◽  
Coronary Syndrome

Objective To examine whether patients who participated in a cardiac rehabilitation (CR) program after hospitalization for acute coronary syndrome maintained cardiorespiratory fitness (CRF) in the community.Methods We conducted a retrospective study including 78 patients who underwent percutaneous coronary intervention or coronary artery bypass graft surgery at our hospital’s cardiovascular center and participated in a CR program and a 5-year follow-up evaluation. Patients were divided into a center-based CR (CBCR) group, participating in an electrocardiography-monitored exercise training in a hospital setting, and a home-based CR (HBCR) group, receiving aerobic exercise training and performed self-exercise at home.Results No significant differences were found between groups (p>0.05), except the proportion of non-smokers (CBCR 59.5% vs. HBCR 31.7%; p=0.01). In both groups, the maximal oxygen consumption (VO<sub>2max</sub>) increased significantly during the first 12 weeks of follow-up and remained at a steady state for the first year, but it decreased after the 1-year follow-up. Particularly, VO<sub>2max</sub> at 5 years decreased below the baseline value in the HBCR group. In the low CRF group, the CRF level significantly improved at 12 weeks, peaked at 1 year, and was still significantly different from the baseline value after 5 years. The high CRF group did not show any significant increase over time relative to the baseline value, but most patients in the high CRF group maintained relatively appropriate CRF levels after 5 years.Conclusion Continuous support should be provided to patients to maintain optimal CRF levels after completing a CR program.

Coronary artery bypass graft surgery

2021 ◽  
pp. 565-584
Author(s):  
Piroze M Davierwala ◽  
Michael A Borger
Keyword(s):  
Acute Coronary Syndrome ◽  
Coronary Artery ◽  
Coronary Artery Bypass Graft ◽  
Coronary Artery Bypass ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Coronary Intervention ◽  
Artery Bypass Graft ◽  
Coronary Syndrome ◽  
Cardiac Surgeon

The surgical management of acute coronary syndrome still remains a challenge for the cardiac surgeon. Although most patients can be managed by percutaneous coronary intervention, for patients with complex multivessel or left main coronary artery disease (high SYNTAX score), in whom percutaneous coronary intervention is not possible or is unsuccessful, urgent or emergent coronary artery bypass graft surgery is the only available option. It is very important for surgeons to determine the optimum timing of surgical intervention, which is usually based on the clinical presentation, coronary anatomy, and biomarkers. Surgeons should be conversant with the different operative techniques, whether off- or on-pump coronary artery bypass graft surgery, that would help in achieving the best possible outcomes in such situations. Early and late survival of patients depends not only on an efficiently executed operation, but also on the competency of the post-operative care delivered. Modern perioperative management is reinforced by the availability of a variety of mechanical cardiopulmonary assist devices, like the intra-aortic balloon pump, the extracorporeal membrane oxygenation, and an array of ventricular assist devices, which aid us in managing very sick patients presenting with cardiogenic shock. The results of coronary artery bypass graft surgery for acute coronary syndrome, as published in the literature, vary significantly, because of the heterogeneity of patient populations, operative timing, and haemodynamic status, making a comparison of surgical outcomes almost impossible. Only one randomized trial has been conducted to that effect, to date. A heart team approach, involving an interventional cardiologist and a cardiac surgeon, is mandatory to determine the best treatment strategy and achieve the best possible outcomes in patients with acute coronary syndrome.

scholarly journals The potential interaction of statins and clopidogrel in patients undergoing percutaneous coronary intervention

2021 ◽  
Vol 8 (3) ◽  
pp. 112-119
Author(s):  
Ibrahim et al. ◽  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Coronary Intervention ◽  
Potential Interaction ◽  
Cardiac Events ◽  
Cross Sectional ◽  
Beneficial Effects ◽  
Coronary Syndrome ◽  
Adverse Cardiac Events ◽  
Percutaneous Coronary ◽  
The Impact

Clopidogrel is widely used for patients with acute coronary syndrome. It is a pro-drug that requires bioactivation by several cytochrome P450 (CYP) enzymes, mainly CYP3A4, CYP2C9, and CYP2C19 enzymes. Lipophilic statins such as atorvastatin are used concomitantly with clopidogrel due to their beneficial effects on morbidity and mortality in the arena of cardiovascular diseases. However, lipophilic statins are eliminated by CYP3A4 and undergo the same metabolic pathway of clopidogrel. Hence, statins may compete with clopidogrel for CYP3A4 enzyme resulting in diminishing the anti-platelet effect of clopidogrel. We aimed to study the impact of concomitant statin therapy on clopidogrel efficacy in patients undergoing percutaneous coronary intervention (PCI) evaluate the clinical relevance of potential clopidogrel and statins interaction and association between use of statins and risk of future adverse cardiac events. A cross-sectional retrospective cohort study was conducted on 50 patients attending Prince Sultan Cardiac Center for follow-up after PCI. All patients discharged on clopidogrel, aspirin, and atorvastatin were later divided into two groups according to the occurrence of MACEs. Statistical analysis was performed by Statistical Package for the Social Science (SPSS; V. 21.0). This study was on adult and geriatric males (72%)and female (28%). More than half of them exhibited major adverse cardiac events (MACEs), of which 48% exhibited it after 4 to 6 months from PCI indexing followed by 1 to 3 months (34%), and the least after 7 to 9 months. A significant association arises between gender and MACEs (P=0.042). Moreover, the average age was significantly higher in patients who experience MACEs compared to others (62.7 vs. 55.4, P=0.037). Regarding comorbidities, hypertension increased in patients with MACEs (73.1%) compared to those without MACEs (45.8%). The average duration of taking clopidogrel was significantly shorter in patients with MACEs compared to those who did not (3.42 vs. 5.54 months, P<0.001). According to the findings of this study, atorvastatin affects clopidogrel efficacy in patients undergoing PCI.

Abstract 241: Registry vs. Real World: Revascularization Treatment and In-Hospital Mortality Among STEMI Patients

2016 ◽  
Vol 9 (suppl_2) ◽  
Author(s):  
Elizabeth B Pathak
Keyword(s):  
Black Women ◽  
Hospital Mortality ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Patient Characteristics ◽  
Coronary Intervention ◽  
Stemi Patient ◽  
Patient Treatment ◽  
Discharge Data ◽  
Gender Groups

Objective: Hospital-based cardiovascular disease registries provide important clinical data on treatments and outcomes. However, the voluntary paid-membership nature of these registries makes them vulnerable to selection bias. In this study, recent ST-elevation myocardial infarction (STEMI) patient treatment rates were compared between registry and non-registry hospitals. Methods: The published list of Florida hospitals in the Acute Coronary Treatment and Intervention Outcomes Network (ACTION) Registry during 2013-2014 was obtained from the ACTION website. All-payer hospital discharge data with 100% coverage were analyzed. STEMI patient characteristics, treatment, and outcomes were compared for registry vs. non-registry hospitals for one year, using detailed ICD-9-CM diagnosis and procedure codes. Treatments identified were primary percutaneous coronary intervention (PCI), coronary artery bypass graft surgery (CABG), and infusion/injection of fibrinolytic drugs (LYTICS). Results: A minority of acute-care hospitals participated in the ACTION registry in Florida during 2013-2014, admitting 1/3 of STEMI patients. Statewide, there were 10,592 STEMI patients hospitalized. In the ACTION hospitals, treatment rates were: same-day PCI = 70.5%, CABG = 8.7%, PCI on a later day = 6.2%, PCI with timing unknown = 2.5%, LYTICS alone = 0.1%. Patients who received no treatment comprised 12.1% of patients in registry hospitals vs. 15.6% in non-registry hospitals. Registry no treatment rates were lower for all race-gender groups, with the greatest difference in Black women (15.7% vs. 21.8% no treatment). Treatment rates varied by age (see Figure). After Medicare eligibility age (65+), treatment differences narrowed. Unadjusted in-hospital mortality rates were greater in non-registry hospitals for patients who received same-day PCI (5.3% vs. 4.1%) and PCI later (5.5% vs. 2.5%), but were lower for CABG patients (5.3% vs. 8.0%). Conclusions: Patients treated at non-ACTION hospitals were somewhat less likely to receive any revascularization therapy, and had higher overall unadjusted rates of mortality. Registry participating institutions may be a selected “best practices” group of hospitals, from which national generalizations should be derived with caution.

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