Influence of cardiac rehabilitation on natriuretic peptides.

OBJECTIVE: Cardiac rehabilitation programmes result in reduced morbidity and mortality and improvement of functional class. Behaviour of natriuretic peptides coupled to these programmes is not well established. Our study's objective is to evaluate the behaviour of natriuretic peptides in a sample of patients undergoing a cardiac rehabilitation programme. METHODS AND RESULTS: Moderate to high-risk patients undergoing a cardiac rehabilitation programme were included. Demographic and clinical characteristics were recorded. We performed four N-terminal pro-brain natriuretic peptide (NT-proBNP) plasma determinations: on the first and last programme day, before and after training. To evaluate functional capacity, a stress test before and after the exercise programme was performed. Eighty-three patients were included. Exercise produces increased levels of NT-proBNP, although in the last exercise session the increase was lower (35.91 vs. 31.49 ng/ml (P = 0.71)). Patients with left ventricular dysfunction present higher NT-proBNP levels. After the rehabilitation programme we observed a significant improvement of functional capacity by 1.5 METS on average (P = 0.001), but not in the subgroup with lower NT-proBNP levels. CONCLUSIONS: Basal levels of peptides did not change significantly after the programme but rose with the workout, especially in patients with left ventricular dysfunction. Patients with higher baseline levels obtained greater functional recovery. We conclude that NT-proBNP measurement may be useful in selecting patients to perform a cardiac rehabilitation programme.

[Postmyocardial infarction cardiac rehabilitation in low risk patients. Results with a coordinated program of cardiological and primary care]. / Rehabilitación cardíaca postinfarto de miocardio en enfermos de bajo riesgo. Resultados de un programa de coordinación entre cardiología y atención primaria.

INTRODUCTION AND OBJECTIVES: To assess the efficacy of cardiac rehabilitation with a mixed primary and cardiological care program in patients with low-risk myocardial infarction. PATIENTS AND METHOD: The participants in this 12-month prospective study were 153 consecutive patients with low-risk myocardial infarction (MI) referred to their primary care center for follow-up care. Of these patients, 113 were referred to a mixed primary and specialized care program that included physical exercise, cardiovascular risk control, an antismoking program, health education talks and psychological evaluation. The other 40 patients served as controls. We analyzed the results after 3 months and 1 year of follow-up. RESULTS: There were no differences between the two groups at baseline. After 1 year, improvements were seen in smoking habit (4.6% vs 15.6%; P<.05) and body mass index (26 [2] vs 29 [2]; P<.05). Dyslipidemia, glucose and blood pressure were similar in both groups after follow-up. Greater improvements in the group of patients who participated in the program were seen after 1 year in quality of life (78 [2] vs 91 [2]; P<.05), exercise capacity (10.3 [2] vs 8.4 [3]; P<<.01) and return to active employment (84.6% vs 53.3%; P<.05). CONCLUSIONS: After 1 year of follow-up, the cardiac rehabilitation program coordinated by cardiological and primary care services for low-risk post-MI patients improved quality of life, and increased exercise tolerance, active employment, and the number of participants who quit smoking. The mixed program also reduced body mass index. These results suggest the need for similar programs.

Rehabilitación cardíaca postinfarto de miocardio en enfermos de bajo riesgo. Resultados de un programa de coordinación entre cardiología y atención primaria / Postmyocardial infarction cardiac rehabilitation in low risk patients. Results with a coordinated program of cardiological and primary care

Introducción y objetivos. Evaluar la eficacia de un programa de rehabilitación cardíaca para pacientes con infartos de miocardio de bajo riesgo coordinados por la cardiología especializada y en colaboración con atención primaria. Pacientes y método. Un total de 153 pacientes con infarto de miocardio de bajo riesgo fueron remitidos de forma consecutiva al centro de atención primaria para proseguir con el control evolutivo. En 113 pacientes se aplicó un programa conjunto que incluía ejercicio físico, control de los factores de riesgo, programa antitabaco, charlas de educación sanitaria y valoración psicológica Los 40 pacientes restantes en los que no se aplicó el programa formaron el grupo control. Resultados. No se observaron diferencias basales entre los 2 grupos. A los 3 y a los 12 meses mejoró el abandono de tabaco (4,6 frente al 15,6 por ciento a los 12 meses; p < 0,05) y el índice de masa corporal (26 ñ 2 frente a 29 ñ 2 a los 12 meses; p < 0,05). La dislipemia, la glucemia y la presión arterial estuvieron controladas por igual. El grupo activo mejoró la calidad de vida al año de seguimiento (78 ñ 2 frente a 91 ñ 2, p < 0,05), la capacidad de esfuerzo medida en equivalentes metabólicos (10,3 ñ 2 frente a 8,4 ñ 3; p < 0,01) y el retorno laboral (el 84,6 frente al 53,3 por ciento; p < 0,05).Conclusiones. En enfermos con antecedentes de infarto de miocardio de bajo riesgo que realizan un programa de rehabilitación cardíaca coordinado entre cardiología y atención primaria se observa una mejoría de la calidad de vida y de la tolerancia al esfuerzo, un mayor retorno laboral, un mayor abandono del hábito tabáquico y una disminución del índice de masa corporal al año de seguimiento. Estos resultados indican la necesidad de potenciar programas similares (AU)

Triflusal versus oral anticoagulation for primary prevention of thromboembolism after bioprosthetic valve replacement (TRAC): rationale and design for a prospective, randomized, co-operative trial.

Antiplatelet agents are used for prevention of thromboembolism in surgical patients and in patients with chronic atrial fibrillation. However, up-to-date results of randomized studies comparing antiplatelet agents and oral anticoagulation have not been reported. The aim of this study is to compare the efficacy and safety profile of triflusal versus acenocoumarol for primary prevention of thromboembolism in the early postoperative period after implantation of a bioprosthesis. This is a prospective, multicentric, randomized, open, pilot trial in which four acute-care teaching hospitals participate. Patients will be randomly assigned to treatment with triflusal or acenocoumarol the day before valve replacement with a bioprosthesis. Primary outcome will be the combined endpoint of the rate of either thromboembolism or hemorrhage and valve-related mortality in each treatment group. Secondary outcomes will include the analysis of each of these rates separately together with permanent valve-related impairment according to the guidelines for reporting morbidity and mortality after cardiac valvular operations. A total of 200 patients will be recruited in a competitive manner (100 patients per arm) over an 18-month period. The study will be completed in 2 years. Treatment assigned will be open to investigators and patients because of the need of blood monitoring and dosage adjustment in oral anticoagulant therapy. In order to minimize the bias, randomization is centrally performed. The study medication will be given for 3 months being discontinued afterwards. Follow-up visits are scheduled at the time of patient's inclusion in the study and at 1, 3, and 6 months thereafter. Homogeneity of groups will be analyzed using the Student's t test, the Mann-Whitney U test, and the chi-square test, when appropriate. Rates of thromboembolism and hemorrhage will be calculated with the hazard function. In conclusion, antiplatelet treatment for patients undergoing valve replacement with a bioprosthesis is clinically relevant because of avoidance of inconveniences of oral anticoagulation (monthly blood testing, dosage adjustment) and decreased risk of bleeding. In case the results favor the use of antiplatelet drugs in these patients, this study will contribute to future development of strategies in the prevention of thromboembolism.