ABSTRACT
BACKGROUND: Center-based cardiac rehabilitation (CBCR) improves health outcomes but has some limitations. We designed and validated a telerehabilitation system to overcome these barriers. METHODS: We included 67 low-risk acute coronary syndrome patients in a randomized controlled trial allocated 1:1 to a 10-month cardiac telerehabilitation (CTR) program or an 8-week CBCR program. Patients underwent ergospirometry, blood tests, anthropometric measurements, IPAQ, PREDIMED, HADS, and EQ-5D questionnaires at baseline and 10 months. Data collectors were blinded to the treatment groups. RESULTS: The intention-to-treat analysis included 31 patients in the CTR group and 28 patients in the CBCR group. The primary outcome showed increased physical activity according to the IPAQ survey in the CTR group compared to the CBCR group (median increase 1726 METS-min/week vs. 636, p = .045). Mean VO2max increased 1.62 ml/(kg min) (95% confidence interval [CI]: 0.56-2.69, p < .004) from baseline in the CTR group, and 0.60 mL/(kg min) (p = .40) in the CBCR group. Mean apoB/apoA-I ratio decreased 0.13 (95% CI: -0.03 to 0.24, p = .017) in the CTR group, with no significant change in the CBCR group (p = .092). The median non-HDL cholesterol increased by 7.3 mg/dl (IQR: -2.4 to 18.6, p = .021) in the CBCR group, but the increase was not significant in the CTR group (p = .080). Adherence to a Mediterranean diet, psychological distress, and quality of life showed greater improvement in the CTR group than in the CBCR group. Return-to-work time was reduced with the telerehabilitation strategy. CONCLUSION: This system allows minimal in-hospital training and prolonged follow-up. This strategy showed better results than CBCR.
Subject(s)
Acute Coronary Syndrome , Cardiac Rehabilitation , Telerehabilitation , Acute Coronary Syndrome/diagnosis , Humans , Quality of Life , Surveys and QuestionnairesABSTRACT
Human dental pulp contains precursor cells termed dental pulp stem cells (DPSC) that show self-renewal and multilineage differentiation and also secrete multiple proangiogenic and antiapoptotic factors. To examine whether these cells could have therapeutic potential in the repair of myocardial infarction (MI), DPSC were infected with a retrovirus encoding the green fluorescent protein (GFP) and expanded ex vivo. Seven days after induction of myocardial infarction by coronary artery ligation, 1.5 x 10(6) GFP-DPSC were injected intramyocardially in nude rats. At 4 weeks, cell-treated animals showed an improvement in cardiac function, observed by percentage changes in anterior wall thickening left ventricular fractional area change, in parallel with a reduction in infarct size. No histologic evidence was seen of GFP+ endothelial cells, smooth muscle cells, or cardiac muscle cells within the infarct. However, angiogenesis was increased relative to control-treated animals. Taken together, these data suggest that DPSC could provide a novel alternative cell population for cardiac repair, at least in the setting of acute MI.
Subject(s)
Dental Pulp/cytology , Myocardial Infarction/pathology , Myocardial Infarction/therapy , Neovascularization, Physiologic , Stem Cell Transplantation , Stem Cells/cytology , Ventricular Function, Left/physiology , Adolescent , Adult , Animals , Cell Differentiation , Cell Proliferation , Cell- and Tissue-Based Therapy , Dental Pulp/transplantation , Dental Pulp/ultrastructure , Dental Pulp/virology , Humans , Male , Mesenchymal Stem Cells/cytology , Myocardial Infarction/diagnostic imaging , Myocardial Infarction/physiopathology , Myocytes, Cardiac/cytology , Myocytes, Smooth Muscle/cytology , Rats , Rats, Nude , Retroviridae , Retroviridae Infections , Stem Cells/ultrastructure , Stem Cells/virology , UltrasonographyABSTRACT
INTRODUCTION AND OBJECTIVES: Recent studies show that the prevalence of anemia in patients with heart failure is high and indicate that its presence leads to increased mortality and morbidity. Our aims were to determine the prevalence of anemia in patients hospitalized for heart failure and to study the long-term prognostic significance of anemia by evaluating its relationship with mortality (total and due to heart failure) and readmission for heart failure. METHODS: The study included 242 consecutive patients admitted to our cardiology department and discharged with a diagnosis of congestive heart failure. The Kaplan-Meier technique and Cox regression modeling were used to determine whether anemia is an independent predictor of death or readmission for heart failure. Anemia was defined as a hemoglobin level <12 g/dL. The mean follow-up period was 23.5 (10.9) months. RESULTS: Overall, 79 patients (32.6%) were anemic. During follow-up, 77 died (53 due to heart disease) and 117 were readmitted for heart failure. Multivariate analysis showed that anemia was an independent predictor of death (hazard ratio [HR]=1.85, 95% confidence interval [CI], 1.12-3.06), death due to heart disease (HR=1.88, 95% CI, 1.03-3.45), and readmission for heart failure (HR=1.87, 95% CI, 1.28-2.74). CONCLUSIONS: The prevalence of anemia was high in patients hospitalized for heart failure. Moreover, a discharge hemoglobin level less than 12 g/dL was a predictor of all-cause death, cardiac death, and readmission for heart failure.
Subject(s)
Anemia/epidemiology , Heart Failure/blood , Hemoglobin A/analysis , Adult , Aged , Aged, 80 and over , Anemia/blood , Anemia/mortality , Female , Heart Failure/mortality , Humans , Male , Middle Aged , Multivariate Analysis , Patient Readmission , Prevalence , Prognosis , Proportional Hazards Models , Sex FactorsSubject(s)
Acenocoumarol/adverse effects , Anticoagulants/adverse effects , Aspirin/adverse effects , Hemorrhage/chemically induced , Platelet Aggregation Inhibitors/adverse effects , Ticlopidine/analogs & derivatives , Acenocoumarol/administration & dosage , Aged , Anticoagulants/administration & dosage , Aspirin/administration & dosage , Clopidogrel , Drug Therapy, Combination , Female , Humans , Male , Platelet Aggregation Inhibitors/administration & dosage , Ticlopidine/administration & dosage , Ticlopidine/adverse effectsABSTRACT
Introducción y objetivos. Estudios recientes muestran una elevada prevalencia de anemia en pacientes con insuficiencia cardiaca y señalan que su presencia condiciona un aumento de la morbimortalidad. El objetivo de nuestro estudio fue determinar la prevalencia de anemia en pacientes dados de alta con diagnóstico de insuficiencia cardiaca, estudiar su valor pronóstico a largo plazo y evaluar la relación entre anemia y mortalidad (total y cardiaca) y reingresos por nueva descompensación. Métodos. Analizamos una serie de 242 pacientes ingresados en el servicio de cardiología y dados de alta con diagnóstico de insuficiencia cardiaca. Utilizamos el método de Kaplan-Meier y el modelo de regresión de Cox para el estudio de la anemia como predictor independiente de mortalidad y reingresos por insuficiencia cardiaca. Consideramos anemia una cifra de hemoglobina < 12 g/dl. El tiempo medio de seguimiento fue de 23,5 ± 10,9 meses. Resultados. En total, 79 (32,6%) pacientes tenían anemia. Durante el seguimiento fallecieron 77 pacientes, 53 por causa cardiaca, y reingresaron por insuficiencia cardiaca 117 pacientes. En el análisis multivariable, la anemia resultó predictora de mortalidad total (hazard ratio [HR] = 1,85; intervalo de confianza [IC] del 95%, 1,12-3,06), mortalidad cardiaca (HR = 1,88; IC del 95%, 1,03-3,45) y reingreso por insuficiencia cardiaca (HR = 1,87; IC del 95%, 1,28-2,74). Conclusiones. En nuestra serie de pacientes hospitalizados por insuficiencia cardiaca observamos una elevada prevalencia de anemia. Además, una cifra de hemoglobina en el momento del alta < 12 g/dl resultó predictora de mortalidad total, mortalidad cardiaca y reingreso por descompensación de la insuficiencia cardiaca
Introduction and objectives. Recent studies show that the prevalence of anemia in patients with heart failure is high and indicate that its presence leads to increased mortality and morbidity. Our aims were to determine the prevalence of anemia in patients hospitalized for heart failure and to study the long-term prognostic significance of anemia by evaluating its relationship with mortality (total and due to heart failure) and readmission for heart failure. Methods. The study included 242 consecutive patients admitted to our cardiology department and discharged with a diagnosis of congestive heart failure. The Kaplan-Meier technique and Cox regression modeling were used to determine whether anemia is an independent predictor of death or readmission for heart failure. Anemia was defined as a hemoglobin level <12 g/dL. The mean follow-up period was 23.5 (10.9) months. Results. Overall, 79 patients (32.6%) were anemic. During follow-up, 77 died (53 due to heart disease) and 117 were readmitted for heart failure. Multivariate analysis showed that anemia was an independent predictor of death (hazard ratio [HR]=1.85, 95% confidence interval [CI], 1.12-3.06), death due to heart disease (HR=1.88, 95% CI, 1.03-3.45), and readmission for heart failure (HR=1.87, 95% CI, 1.28-2.74). Conclusions. The prevalence of anemia was high in patients hospitalized for heart failure. Moreover, a discharge hemoglobin level less than 12 g/dL was a predictor of all-cause death, cardiac death, and readmission for heart failure
Subject(s)
Male , Female , Adult , Middle Aged , Aged , Humans , Hemoglobin A/analysis , Heart Failure/blood , Patient Discharge , Prognosis , Anemia/complicationsABSTRACT
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