Cardiac rehabilitation in patients with pacemakers and implantable cardioverter defibrillators

Large subsets of patients admitted in cardiac rehabilitation centers are having a pacemaker, cardiac resynchronization (CRT) or implantable cardiac defibrillator (ICD). Cardiac rehabilitation for patients, mostly with heart failure, with implanted electronic devices as pacemakers or ICD is a unique opportunity not only to optimize the medical treatment, to increase their exercise capacity and improves their clinical condition but also to supervise the correct functioning of the device. CRT reduces clinical symptoms and increases slightly the exercise capacity. But in these patients, the clinical improvements are likely to be explained by both the enhancement of cardiac function induced by the device and by the improved peripheral (muscular and vascular) and cardiac effects of exercise. The additional expected gain by exercise in this population is between 14 to 25%. In patients implanted with an ICD, exercise training is safe, without increasing shocks or anti-tachycardia pacing therapy. The comprehensive cardiac rehabilitation combining exercise training and a psycho-educational intervention improves exercise capacity, quality of life, general and mental health. Nevertheless, further large scale studies was needed to evaluate the most appropriate management and demonstrate definitively the role of cardiac rehabilitation in this particular group of patients

Kinetics of functional recovery after foot and ankle surgery. Comparison of EFAS and SF36 scores

International audienceIntroduction: The EFAS score is a new recently validated European quality of life score for foot and ankle surgery, comprising 6 questions on activities of daily living (ADL) and 4 on sport. The aim of the present study was to assess the kinetics of functional recovery on the EFAS and SF36 scores, and to assess correlations between the two at 0 to 6 months then 6 months to 1 year in a population of foot and ankle surgery patients, globally and per pathology. Hypothesis: Hindfoot and ankle surgery requires at least 1 year's follow-up for assessment of recovery, whereas 6 months is sufficient to assess forefoot recovery. Material and methods: A multicenter prospective cohort study included all patients undergoing surgery for foot and ankle pathology between December 2015 and July 2016. Statistical analysis, global and per pathology, was performed preoperatively and at 6 months and 1 year. Results: In total, 98 patients were assessed at 1 year. In the global population, EFAS ADL score improved by 17.1 ± 22.1 points (hindfoot, 16.9 ± 24.6; forefoot, 19.7 ± 21.4) and global SF36 score by 8.7 ± 17.1 points (hindfoot, 10.2 ± 19.1; forefoot, 9.6 ± 15.9). Both scores progressed between 6 months and 1 year for hindfoot pathologies, whereas they remained constant after 6 months for the forefoot. The EFAS score showed weak correlation with SF36

Impact of training on combined cardiopulmonary exercise test with stress echocardiography parameters in HFrEF patients

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