105 research outputs found
Exercise Intervention to Improve Functional Capacity in Older Adults After Acute Coronary Syndrome
More than one-half of patients admitted for acute
coronary syndrome (ACS) are age 70
years, hospitalization for ACS, and Short Physical
Performance Battery (SPPB) score between 4 and 9 at
the inclusion visit (30 5 days after hospital
discharge). The SPPB is a scale that combines gait
speed, chair stand, and balance tests. It ranges from
0 (worst) to 12 (best) and has predictive validity for
mortality (4). Participants were randomized to usual
care and health education (control group) or usual
care and PA intervention (intervention group). The
control group received a 20-min session and a
detailed brochure stressing the importance of PA
in cardiovascular health. The PA intervention consisted of four supervised sessions (1, 2, 3, and
4 months after hospital discharge), combined with an
individualized home-based PA program. Centerbased sessions included a moderate standardized
treadmill-walk, strength, and balance exercises (3). After the practice sessions, patients received a
tailored PA home program (3). Weekly energy
expenditure from PA was determined by a selfreported 7-day physical activity recall (kcal/week),
and objectively measured by wearing an accelerometer (min/week). The primary endpoint was the 6-
month SPPB. Secondary endpoints were 1-year SPPB
and time engaged in PA.
From January 2017 to April 2018, 235 patients were
randomized (n ¼ 117, control group; n ¼ 118, intervention group). The median age was 76 (interquartile
range [IQR]: 73 to 81) years, and 23% were female.
Before the hospitalization, light and moderateintensive PA was performed by 66% and 14% of patients, respectively. Baseline characteristics, as well
as baseline SPPB value (Figure 1), did not differ between groups. The adherence rates of the PA intervention group to the 1-, 2-, 3-, and 4-month
scheduled supervised sessions were 100%, 89%,
85%, and 72%, respectively. The time engaged in PA
progressively and significantly increased in the
intervention group (Figure 1). At 6 months, the SPPB
score was significantly higher in the intervention
group (median: 9 [IQR: 8 to 11] vs. 7 [IQR: 5 to 8];
p < 0.001) (Figure 1). This improvement was supported by a significant increase in SPPB components
of walking and chair rise (balance remained unchanged). The number of patients showing an increase of at least 1 point in SPPB score was 86 (74%)
in the intervention group versus 46 (40%) in the
control group (p < 0.001). The SPPB increase was
maintained at the 1-year visit (Figure 1) and independent of sex and educational status.
Typical CR/SP includes 3 weekly supervised exercise and educational sessions for 12 weeks.
Despite the health benefits associated with these
interventions, few eligible patients are referred or
complete such programs (1). Our novel PA intervention was designed to address this issue. The
attendance rate was high (72% [95% confidence interval: 64% to 80%]). The average weekly energy
expenditure from PA in the intervention group
increased 3.4 times, and SPPB score showed a mean
increment of 2.0 points. This finding is notable
given that an SPPB improvement of 1.0 point is
generally considered a substantial clinically meaningful change (2). In addition, despite the absence of supervised sessions after the sixth month, the
achievements were maintained until 1-year visit.
If confirmed in future studies, our PA intervention
model might help to mitigate the challenges related to
limited health care resources and might increase the
number of older adults receiving CR/SP
Contrast associated acute kidney injury and mortality in older adults with acute coronary syndrome: A pooled analysis of the fraser and hulk studies
Whether contrast-associated acute kidney injury (CA-AKI) is only a bystander or a risk factor for mortality in older patients undergoing percutaneous coronary intervention (PCI) is not well understood. Data from FRASER (NCT02386124) and HULK (NCT03021044) studies have been analysed. All patients enrolled underwent coronary angiography. The occurrence of CA-AKI was defined based on KDIGO criteria. The primary outcome of the study was to test the relation between CA-AKI and 3-month mortality. Overall, 870 older ACS adults were included in the analysis (mean age 78 ± 5 years; 28% females). CA-AKI occurred in 136 (16%) patients. At 3 months, 13 (9.6%) patients with CA-AKI died as compared with 13 (1.8%) without it (p < 0.001). At multivariable analysis, CA-AKI emerged as independent predictor of 3-month mortality (HR 3.51, 95%CI 1.05–7.01). After 3 months, renal function returned to the baseline value in 78 (63%) with CA-AKI. Those without recovered renal function (n = 45, 37%) showed an increased risk of mortality as compared to recovered renal function and no CA-AKI subgroups (HR 2.01, 95%CI 1.55–2.59, p = 0.009 and HR 2.71, 95%CI 1.45–5.89, p < 0.001, respectively). In conclusion, CA-AKI occurs in a not negligible portion of older MI patients undergoing invasive strategy and it is associated with short-term mortality
Adherence to Gluten-Free Diet Restores Alpha Diversity in Celiac People but the Microbiome Composition Is Different to Healthy People
Celiac disease (CD) is an autoimmune disease with the destruction of small intestinal villi, which occurs in genetically predisposed individuals. At the present moment, a gluten-free diet (GFD) is the only way to restore the functionality of gut mucosa. However, there is an open debate on the effects of long-term supplementation through a GFD, because some authors report an unbalance in microbial taxa composition. Methods: For microbiome analysis, fecal specimens were collected from 46 CD individuals in GFD for at least 2 years and 30 specimens from the healthy controls (HC). Data were analyzed using an ensemble of software packages: QIIME2, Coda-lasso, Clr-lasso, Selbal, PICRUSt2, ALDEx2, dissimilarity-overlap analysis, and dysbiosis detection tests. Results: The adherence to GFD restored the alpha biodiversity of the gut microbiota in celiac people but microbial composition at beta diversity resulted as different to HC. The microbial composition of the CD subjects was decreased in a number of taxa, namely Bifidobacterium longum and several belonging to Lachnospiraceae family, whereas Bacteroides genus was found to be more abundant. Predicted metabolic pathways among the CD bacterial communities revealed an important role in tetrapyrrole biosynthesis. Conclusions: CD patients in GFD had a non-dysbiotic microbial composition for the crude alpha diversity metrics. We found significant differences in beta diversity, in certain taxon, and pathways between subjects with inactive CD in GFD and controls. Collectively, our data may suggest the development of new GFD products by modulating the gut microbiota through diet, supplements of vitamins, and the addition of specific prebiotics
Physical activity intervention for elderly patients with reduced physical performance after acute coronary syndrome (HULK study): Rationale and design of a randomized clinical trial
Background: Reduced physical performance and impaired mobility are common in elderly patients after acute coronary syndrome (ACS) and they represent independent risk factors for disability, morbidity, hospital readmission and mortality. Regular physical exercise represents a means for improving functional capacity. Nevertheless, its clinical benefit has been less investigated in elderly patients in the early phase after ACS. The HULK trial aims to investigate the clinical benefit of an early, tailored low-cost physical activity intervention in comparison to standard of care in elderly ACS patients with reduced physical performance. Design: HULK is an investigator-initiated, prospective multicenter randomized controlled trial (NCT03021044). After successful management of the ACS acute phase and uneventful first 1 month, elderly (≥70 years) patients showing reduced physical performance are randomized (1:1 ratio) to either standard of care or physical activity intervention. Reduced physical performance is defined as a short physical performance battery (SPPB) score of 4-9. The early, tailored, low-cost physical intervention includes 4 sessions of physical activity with a supervisor and an home-based program of physical exercise. The chosen primary endpoint is the 6-month SPPB value. Secondary endpoints briefly include quality of life, on-treatment platelet reactivity, some laboratory data and clinical adverse events. To demonstrate an increase of at least one SPPB point in the experimental arm, a sample size of 226 patients is needed. Conclusions: The HULK study will test the hypothesis that an early, tailored low-cost physical activity intervention improves physical performance, quality of life, frailty status and outcome in elderly ACS patients with reduced physical performance
Effectiveness and safety of vedolizumab in a matched cohort of elderly and nonelderly patients with inflammatory bowel disease: the IG-IBD LIVE study
Investigation of Multiple Susceptibility Loci for Inflammatory Bowel Disease in an Italian Cohort of Patients
BACKGROUND: Recent GWAs and meta-analyses have outlined about 100 susceptibility genes/loci for inflammatory bowel diseases (IBD). In this study we aimed to investigate the influence of SNPs tagging the genes/loci PTGER4, TNFSF15, NKX2-3, ZNF365, IFNG, PTPN2, PSMG1, and HLA in a large pediatric- and adult-onset IBD Italian cohort. METHODS: Eight SNPs were assessed in 1,070 Crohn's disease (CD), 1,213 ulcerative colitis (UC), 557 of whom being diagnosed at the age of ≤16 years, and 789 healthy controls. Correlations with sub-phenotypes and major variants of NOD2 gene were investigated. RESULTS: The SNPs tagging the TNFSF15, NKX2-3, ZNF365, and PTPN2 genes were associated with CD (P values ranging from 0.037 to 7×10(-6)). The SNPs tagging the PTGER4, NKX2-3, ZNF365, IFNG, PSMG1, and HLA area were associated with UC (P values 0.047 to 4×10(-5)). In the pediatric cohort the associations of TNFSF15, NKX2-3 with CD, and PTGER4, NKX2-3, ZNF365, IFNG, PSMG1 with UC, were confirmed. Association with TNFSF15 and pediatric UC was also reported. A correlation with NKX2-3 and need for surgery (P  =  0.038), and with HLA and steroid-responsiveness (P  =  0.024) in UC patients was observed. Moreover, significant association in our CD cohort with TNFSF15 SNP and colonic involvement (P  =  0.021), and with ZNF365 and ileal location (P  =  0.024) was demonstrated. CONCLUSIONS: We confirmed in a large Italian cohort the associations with CD and UC of newly identified genes, both in adult and pediatric cohort of patients, with some influence on sub-phenotypes
Fractional flow reserve: Current applications and overview of the available data
Flow fractional reserve (FFR) allows to evaluate the functional significance of coronary artery lesions, through the ratio of the mean coronary artery pressure after the stenosis to the mean aortic pressure during maximum hyperemia. The actual widely accepted cut-off value is 0.80. Below this value a coronary lesion is considered significant and therefore it requires invasive revascularization. Several studies [in particular Fractional Flow Reserve vs Angiography for Multivessel Evaluation 1 (FAME-1) and FAME-2] have shown the relationship between FFR measurement and hard end-points (death, myocardial infarction, and urgent revascularization). Consequently, FFR evaluation represents the cornerstone in the decision-making in intermediate coronary lesions. Recent studies paved the way for further applications of FFR evaluation in complex and tricky clinical settings. In this paper, we perform an overview of the data regarding contemporary application of FFR. In particular, we review the use of FFR in: left main intermediate stenoses, serial stenoses, evaluation after stenting, guidance in coronary artery bypass surgery, and acute coronary syndrome. All the data presented in our overview confirm the essential role of FFR assessment in the daily clinical practice. The shift from "operator-dependent" to "FFR-dependent" evaluation in intermediate coronary artery stenosis is of paramount importance in order to improve the prognosis of our patients, through the discrimination of the functional role of every single coronary stenosis
Frailty in patients admitted to hospital for acute coronary syndrome: When, how and why?
Frailty is an issue of paramount importance for cardiologists, because of the aging of patients admitted to hospital for acute coronary syndrome (ACS) and the straight relationship between aging and frailty. Several tools have been provided in this setting, in order to objectively assess frailty status, but important questions are still unsolved. There are conflicting data about a unique definition of frailty in subjects with cardiovascular diseases, the timing to perform a frailty evaluation in the context of an acute myocardial infarction, the mean to assess frailty in these patients and the usefulness of the information derived from the frailty assessment. Frailty results from the analysis of several items and a multidomain evaluation including laboratory values, clinical data and physical performance assessment is required for a comprehensive frailty assessment. However, regardless of the frailty tool, the prevalence of frailty in older ACS patients is high and it could add important information to the decision-making process about invasive strategy, the multivessel disease management, dual antiplatelet therapy and secondary prevention programs. The present overview tries to summarize the current knowledge about the definition and prevalence of frailty in older adults admitted to hospital for ACS, suggesting how frailty assessment may improve the management of older ACS patients
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