Practice Considerations for Adapting In-Person Groups to Telerehabilitation

The Coronavirus-2019 (COVID-19) pandemic has shifted research and healthcare system priorities, stimulating literature on implementation and evaluation of telerehabilitation for a variety of patient populations. While there is substantial literature on individual telerehabilitation, evidence about group telerehabilitation remains limited despite its increasing use by rehabilitation providers. Therefore, the purpose of this manuscript is to describe our expert team’s consensus on practice considerations for adapting in-person group rehabilitation to group telerehabilitation to provide rapid guidance during a pandemic and create a foundation for sustainability of group telerehabilitation beyond the pandemic’s end. &nbsp

Mediterranean alcohol-drinking pattern, low to moderate alcohol intake and risk of atrial fibrillation in the PREDIMED study

[Background and aims] There is ongoing controversy about the effect of a low to moderate alcohol consumption on atrial fibrillation (AF). Our aim is to assess the association between adherence to a Mediterranean alcohol drinking pattern and AF incidence.[Methods and results] A total 6527 out of the 7447 participants in the PREDIMED trial met our inclusion criteria. A validated frequency food questionnaire was used to measure alcohol consumption. Participants were classified as non-drinkers, Mediterranean alcohol drinking pattern (MADP) (10–30 g/d in men and 5–15 g/day in women, preferably red wine consumption with low spirits consumption), low-moderate drinking (<30 g/day men y and < 15 g/day women), and heavy drinking. We performed multivariable Cox regression models to estimate hazard ratios (HR) with 95% confidence intervals (95% CI) of incident AF according to alcohol drinking patterns. After a mean follow up of 4.4 years, 241 new incident AF cases were confirmed. Alcohol consumption was not associated to AF incidence among low-moderate drinkers (HR: 0.96; 95%CI: 0.67–1.37), adherents to MADP (HR: 1.15 95%CI: 0.75–1.75), or heavy drinkers (HR: 0.92; 95%CI: 0.53–1.58), compared with non-drinkers.[Conclusions] In a high cardiovascular risk adult population, a Mediterranean alcohol consumption pattern (low to moderate red wine consumption) was not associated with an increased incidence of AF.[Clinical trials] URL: http://www.controlled-trials.com. Unique identifier: ISRCTN35739639.PREDIMED trial was supported by the official funding agency for biomedical research of the Spanish government (Instituto de Salud Carlos III) RTIC G03/140 (Coordinator: Dr Estruch) and RTIC RD 06/0045 (Coordinator: Dr Martínez-González). We also acknowledge grants from the National Institutes of Health, United States (1R01HL118264-01); Fondo de Investigación Sanitaria– Fondo Europeo de Desarrollo Regional (PI04/0233, PI05/0976, PI07/0240, PI10/01407, PI10/02658, PI11/00049, PI11/02505 and AGL2010-22319-C03-03); Consejería de Salud de la Junta de Andalucía (PI0105/2007), and by the Generalitat Valenciana, Spain (ACOMP/2013/165 and ACOMP/2013/159)

Asociación entre la fibrilación auricular y el consumo de aceite de oliva, de café y un patrón mediterráneo de consumo de alcohol en las cohortes SUN y PREDIMED

La Fibrilación auricular (FA) es la arritmia más frecuentemente diagnosticada en la población general y se asocia con un empeoramiento en la calidad de vida, una mayor morbimortalidad y un gran impacto en el gasto sanitario. La inflamación es uno de los mecanismos comunes en el desarrollo y perpetuación del remodelado auricular, favoreciendo la aparición de FA.Se han propuesto diferentes intervenciones orientadas a disminuir la carga inflamatoria como medidas de prevención de FA. Nuestro objetivo fue estudiar diferentes compuestos de la dieta con un efecto antiinflamatorio reconocido en parte debido a su contenido en polifenoles: aceite de oliva, vino tinto y café. Utilizamos 2 cohortes, la derivada del estudio PREDIMED (Prevención con dieta Mediterránea) compuesta por 7447 participantes con alto riesgo cardiovascular (42% hombres, media de edad 67 años) y la cohorte SUN (Seguimiento Universidad de Navarra) con 22280 participantes (39% hombres, media de edad 37.5 años). El desenlace estudiado fue el diagnóstico de FA incidente confirmada, realizada en el caso de PREDIMED por un comité de adjudicación de eventos y en el SUN a través de un protocolo de validación de los casos autorreferidos que desarrollamos de forma inédita para el presente trabajo. Utilizamos modelos de regresión de Cox ajustados por posibles factores de confusión y análisis de medidas repetidas para actualizar las exposiciones de aceite de oliva y el vino tinto. En el 1er trabajo estudiamos la asociación entre categorías de consumo de aceite de oliva y riesgo de FA en el estudio SUN. Entre los participantes libres de FA, 94 casos incidentes fueron confirmados (media de seguimiento de 10,1 años). En comparación con la categoría de bajo consumo de AO (25 Kg/m2. En el 2º trabajo, en el que analizamos la asociación entre el riesgo de FA y el consumo de vino tinto en el contexto de un patrón mediterráneo de consumo de alcohol (PMCA) en el estudio PREDIMED, 241 casos fueron diagnosticados (media de seguimiento de 4.4 años). Comparado con los abstemios, el consumo de alcohol no se asoció con el riesgo de FA entre el grupo con consumo bajo-moderado (HR: 0.96; 95% IC 0.67-1.37), con un PMCA (HR: 1.15 95%CI: 0.75-1.75) o aquellos con consumo elevado (HR: 0.92; 95%CI: 0.53-1.58). En el 3er trabajo en el que analizamos la asociación entre el consumo de café y el riesgo de fibrilación auricular fueron diagnosticados 97 casos de FA confirmada en el estudio SUN (media de seguimiento 10.3 años) y 250 en el estudio PREDIMED (media de seguimiento 10.3 años). Tomando como grupo de referencia un consumo 1 taza/semana con HR 0.62 (IC 95% 0.49-1.28). En el estudio SUN se observó un patrón en J similar aunque con resultados no significativos. Sin embargo, en el metaanálisis de ambos estudios, la HR para un consumo intermedio de café fue 0.62 (IC 95% 0.46-0.85). Al analizar el consumo de cafeína total se objetivó un patrón protector similar. Por tanto, concluimos que un consumo intermedio de café con cafeína se asoció con una reducción de riesgo de FA en 2 cohortes mediterráneas. Por otro lado, no objetivamos una asociación entre la FA y con consumo de aceite de oliva y el consumo moderado de vino tinto en el estudio SUN y PREDIMED respectivamente

Mediterranean alcohol-drinking pattern, low to moderate alcohol intake and risk of atrial fibrillation in the PREDIMED study.

There is ongoing controversy about the effect of a low to moderate alcohol consumption on atrial fibrillation (AF). Our aim is to assess the association between adherence to a Mediterranean alcohol drinking pattern and AF incidence. A total 6527 out of the 7447 participants in the PREDIMED trial met our inclusion criteria. A validated frequency food questionnaire was used to measure alcohol consumption. Participants were classified as non-drinkers, Mediterranean alcohol drinking pattern (MADP) (10-30 g/d in men and 5-15 g/day in women, preferably red wine consumption with low spirits consumption), low-moderate drinking ( In a high cardiovascular risk adult population, a Mediterranean alcohol consumption pattern (low to moderate red wine consumption) was not associated with an increased incidence of AF. URL: http://www.controlled-trials.com. Unique identifier: ISRCTN35739639

Mediterranean alcohol-drinking pattern, low to moderate alcohol intake and risk of atrial fibrillation in the PREDIMED study

Background and aims: There is ongoing controversy about the effect of a low to moderate alcohol consumption on atrial fibrillation (AF). Our aim is to assess the association between adherence to a Mediterranean alcohol drinking pattern and AF incidence. Methods and results: A total 6527 out of the 7447 participants in the PREDIMED trial met our inclusion criteria. A validated frequency food questionnaire was used to measure alcohol consumption. Participants were classified as non-drinkers, Mediterranean alcohol drinking pattern (MADP) (10-30 g/d in men and 5-15 g/day in women, preferably red wine consumption with low spirits consumption), low-moderate drinking (<30 g/day men y and < 15 g/day women), and heavy drinking. We performed multivariable Cox regression models to estimate hazard ratios (HR) with 95% confidence intervals (95% CI) of incident AF according to alcohol drinking patterns. After a mean follow up of 4.4 years, 241 new incident AF cases were confirmed. Alcohol consumption was not associated to AF incidence among low-moderate drinkers (HR: 0.96; 95%CI: 0.67-1.37), adherents to MADP (HR: 1.15 95%CI: 0.75-1.75), or heavy drinkers (HR: 0.92; 95%CI: 0.53-1.58), compared with non-drinkers. Conclusions: In a high cardiovascular risk adult population, a Mediterranean alcohol consumption pattern (low to moderate red wine consumption) was not associated with an increased incidence of AF

Caffeinated coffee consumption and risk of atrial fibrillation in two Spanish cohorts

Aims: The association between caffeinated coffee consumption and atrial fibrillation remains unclear. Recent studies suggest an inverse association only between a moderate caffeinated coffee consumption and atrial fibrillation, but others have reported no association. The aim of our study was to prospectively assess the association between caffeinated coffee consumption and atrial fibrillation in two Spanish cohorts, one of adults from a general population and another of elderly participants at high cardiovascular risk. Methods and results: We included 18,983 and 6479 participants from the 'Seguimiento Universidad de Navarra' (SUN) and 'Prevención con Dieta Mediterránea' (PREDIMED) cohorts, respectively. Participants were classified according to their caffeinated coffee consumption in three groups: ≤3 cups/month, 1-7 cups/week, and >1 cup/day. We identified 97 atrial fibrillation cases after a median follow-up of 10.3 years (interquartile range 6.5-13.5), in the SUN cohort and 250 cases after 4.4 years median follow-up (interquartile range 2.8-5.8) in the PREDIMED study. No significant associations were observed in the SUN cohort although a J-shaped association was suggested. A significant inverse association between the intermediate category of caffeinated coffee consumption (1-7 cups/week) and atrial fibrillation was observed in PREDIMED participants with a multivariable-adjusted hazard ratio = 0.53 (95% confidence interval 0.36-0.79) when compared with participants who did not consume caffeinated coffee or did it only occasionally. No association was found for higher levels of caffeinated coffee consumption (>1 cup per day), hazard ratio = 0.79 (95% confidence interval 0.49-1.28). In the meta-analysis of both PREDIMED and SUN studies, the hazard ratio for intermediate consumption of caffeinated coffee was 0.60 (95% confidence interval 0.44-0.82) without evidence of heterogeneity. Similar findings were found for the association between caffeine intake and atrial fibrillation risk. Conclusion: Intermediate levels of caffeinated coffee consumption (1-7 cups/week) were associated with a reduction in atrial fibrillation risk in two prospective Mediterranean cohorts.The author(s) received no financial support for the research, authorship, and/or publication of this article and had full access to all of the data in this study. The SUN Project was supported by the Spanish Government-Instituto de Salud Carlos III, and the European Regional Development Fund (RD 06/0045, PI14/ 01798, PI14/01764, PI17/01795), the Navarra Regional Government, and the University of Navarra. An Advanced Research Grant from the European Research Council to Miguel A Martínez-González (agreement #340918-PREDIMED-Plus) is duly acknowledged. PREDIMED trial was supported by the official funding agency for biomedical research of the Spanish government (Instituto de Salud Carlos III) RTIC G03/140 (Coordinator: Dr Estruch) and RTIC RD 06/0045 (Coordinator: Dr Martínez-González). We also acknowledge grants from the National Institutes of Health, United States (1R01HL118264-01); Fondo de Investigación Sanitaria Fondo Europeo de Desarrollo Regional (PI04/0233, PI05/0976, PI07/0240, PI10/01407, PI10/02658, PI11/00049, PI11/02505 and AGL2010-22319-C03-03); Consejería de Salud de la Junta de Andalucía (PI0105/2007), and by the Generalitat Valenciana, Spain (ACOMP/2013/165 and ACOMP/2013/159)