A Randomized Controlled Trial of an Extensive Lifestyle Management Intervention (ELMI) Following Cardiac Rehabilitation: Study Design and Baseline Data

Background: Cardiac rehabilitation programs (CRP) represent comprehensive interventions thatare typically limited to four months. Following completion of CRP, it appears that risk factors andlifestyle behaviours may deteriorate. The Extensive Lifestyle Management Intervention (ELMI)Following Cardiac Rehabilitation trial will investigate the benefits of a randomized intervention toprevent these adverse changes.Methods: Patients with ischemic heart disease (IHD) were randomized following a standard CRPto the ELMI or to usual care. The ELMI program is a case-managed intervention aimed atindividualizing risk factor and lifestyle management based on current treatment guidelines. Theprogram consists of cardiac rehabilitation sessions, telephone follow-up and risk factor and lifestylecounselling sessions. Health professionals work with participants using behavioural counselling andcommunications with participants\u27 family physicians. Usual care participants return to their familyphysicians\u27 care, and come to the study clinic only to undergo annual outcomes assessment. Theprimary outcome is change in IHD global risk after four years. Secondary outcomes includecombined cardiovascular events, health care utilization, lifestyle adherence, quality of life and riskfactors.Results: Over 28 months, 302 men and women were randomized. This represented 29% of thetotal population screened. The average age of study participants is 64 years, 18% are women, 53%have had a previous myocardial infarction, 73% have undergone previous revascularization and 20%have diabetes mellitus. Ischemic heart disease risk factors for the entire cohort improvedsignificantly after subjects had gone through previous CRPs. Baseline risk factors, lifestylebehaviours and medications were similar between the groups

Cardiac rehabilitation: a comprehensive review

Cardiac rehabilitation (CR) is a commonly used treatment for men and women with cardiovascular disease. To date, no single study has conclusively demonstrated a comprehensive benefit of CR. Numerous individual studies, however, have demonstrated beneficial effects such as improved risk-factor profile, slower disease progression, decreased morbidity, and decreased mortality. This paper will review the evidence for the use of CR and discuss the implications and limitations of these studies. The safety, relevance to special populations, challenges, and future directions of CR will also be reviewed

Statin-Associated Muscle Adverse Events : Update for clinicians

Statins are potent medications which reduce low-density lipoprotein cholesterol (LDL-C) levels. Their efficacy in cardiovascular risk reduction is well established and indications for their use are expanding. While statins are generally well tolerated and safe, adverse events are relatively common, particularly statinassociated muscle adverse events (SaMAEs), which are the most frequently encountered type of adverse event. Recent guidelines and guideline updates on SaMAEs and statin intolerance have included revised definitions of SaMAEs, incorporating new evidence on their pathogenesis and management. As SaMAEs emerge as a therapeutic challenge, it is important for physicians to be aware of updates on management strategies to ensure better patient outcomes. The majority of patients who are considered statin-intolerant can nevertheless tolerate some forms of statin therapy and successfully achieve optimal LDL-C levels. This review article discusses the recent classification of SaMAEs with emphasis on pathogenesis and management strategies.

Predictors of Metabolic Syndrome in Participants of a Cardiac Rehabilitation Program

Metabolic syndrome increases the risk of all-cause mortality, cardiovascular mortality and cardiovascular events in patients with cardiovascular disease (CVD). This study assessed the predictors of metabolic syndrome, both its incidence and resolution in a cohort of cardiac rehabilitation program graduates. Methods. A total of 154 and 80 participants without and with metabolic syndrome respectively were followed for 48 months. Anthropometric measurements, metabolic risk factors, and quality of life were assessed at baseline and at 48 months. Logistic regression models were used to assess the predictors of metabolic syndrome onset and resolution. Results. Increasing waist circumference (OR 1.175, P ≤ 0.001) was an independent predictor for incident metabolic syndrome (R2 for model = 0.46). Increasing waist circumference (OR 1.234, P ≤ 0.001), decreasing HDL-C (OR 0.027, P = 0.005), and increasing triglycerides (OR 3.005, P = 0.003) were predictors of metabolic syndrome resolution. Conclusion. Patients with CVD that further develop metabolic syndrome are particularly susceptible for the cascade of cardiovascular events and mortality. Increasing waist circumference confers a higher risk for future onset of metabolic syndrome in this group of patients. They will require closer follow-up and should be targeted for further prevention strategies after cardiac rehabilitation program completion

Eligibility for cardiac resynchronization therapy in patients hospitalized with heart failure

Aims: Recent guidelines recommend cardiac resynchronization therapy (CRT) in mildly symptomatic heart failure (HF) but favour left bundle branch block (LBBB) morphology in patients with moderate QRS prolongation (120–150 ms). We defined how many patients hospitalized with HF fulfil these criteria. Methods and results: A single-centre retrospective cohort study of 363 consecutive patients hospitalized with HF (438 admissions) was performed. Electronic imaging, electrocardiograms, and records were reviewed. Overall, 153 patients (42%) had left ventricular ejection fraction (LVEF) ≤ 35%, and 34% of patients had QRS prolongation. Eighty patients (22%) were potentially eligible with LVEF ≤ 35% and QRS ≥ 120 ms or existing CRT. The majority (68 of 80) had a Class I or IIa recommendation according to international guidelines (LBBB or non-LBBB QRS ≥ 150 ms or right ventricular pacing). Only a minority (12 of 80) had moderate QRS prolongation of non-LBBB morphology. One-quarter (n = 22) of patients fulfilling criteria were ineligible for reasons including dementia, co-morbidities, or palliative care. A further eight patients required optimization of medical therapy. CRT was therefore immediately indicated in 50 patients. Of these, 29 were implanted or had existing CRT systems. Twenty-one of the 80 patients eligible for CRT were not identified or treated (6% of the total hospitalized cohort). Conclusions: Twenty-two per cent of elderly real-life patients hospitalized with HF fulfil LVEF and QRS criteria for CRT, most having a Class I or IIa indication. However, a large proportion is ineligible owing to co-morbidities or requires medical optimization. Although uptake of CRT was reasonable, there remain opportunities for improvement