Prevalence of mild cognitive impairment in employable patients after acute coronary event in cardiac rehabilitation

Annett Salzwedel,1 Maria-Dorothea Heidler,1,2 Kathrin Haubold,1 Martin Schikora,2 Rona Reibis,3 Karl Wegscheider,4 Michael Jöbges,2 Heinz Völler1,5 1Center for Rehabilitation Research, University of Potsdam, Potsdam, 2Brandenburg Klinik, Bernau, 3Cardiological Outpatient Clinic, Am Park Sanssouci, Potsdam, 4Institute for Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, 5Klinik am See, Rüdersdorf, Germany Introduction: Adequate cognitive function in patients is a prerequisite for successful implementation of patient education and lifestyle coping in comprehensive cardiac rehabilitation (CR) programs. Although the association between cardiovascular diseases and cognitive impairments (CIs) is well known, the prevalence particularly of mild CI in CR and the characteristics of affected patients have been insufficiently investigated so far. Methods: In this prospective observational study, 496 patients (54.5 ± 6.2 years, 79.8% men) with coronary artery disease following an acute coronary event (ACE) were analyzed. Patients were enrolled within 14 days of discharge from the hospital in a 3-week inpatient CR program. Patients were tested for CI using the Montreal Cognitive Assessment (MoCA) upon admission to and discharge from CR. Additionally, sociodemographic, clinical, and physiological variables were documented. The data were analyzed descriptively and in a multivariate stepwise backward elimination regression model with respect to CI. Results: At admission to CR, the CI (MoCA score < 26) was determined in 182 patients (36.7%). Significant differences between CI and no CI groups were identified, and CI group was associated with high prevalence of smoking (65.9 vs 56.7%, P = 0.046), heavy (physically demanding) workloads (26.4 vs 17.8%, P < 0.001), sick leave longer than 1 month prior to CR (28.6 vs 18.5%, P = 0.026), reduced exercise capacity (102.5 vs 118.8 W, P = 0.006), and a shorter 6-min walking distance (401.7 vs 421.3 m, P = 0.021) compared to no CI group. The age- and education-adjusted model showed positive associations with CI only for sick leave more than 1 month prior to ACE (odds ratio [OR] 1.673, 95% confidence interval 1.07–2.79; P = 0.03) and heavy workloads (OR 2.18, 95% confidence interval 1.42–3.36; P < 0.01). Conclusion: The prevalence of CI in CR was considerably high, affecting more than one-third of cardiac patients. Besides age and education level, CI was associated with heavy workloads and a longer sick leave before ACE. Keywords: cardiac rehabilitation, cognitive impairment, prevalence, acute coronary event, patient educatio

Estimulaçao com Adaptaçao de Freqüência Controlada pelo Sistema Nervoso Autônomo - Uma Avaliaçao Clínica

Para o tratamento da incompetência cronotrópica, marcapassos com adaptaçao em freqüência baseados em diferentes sinais de sensores têm sido desenvolvidos, visando restaurar o mecanismo fisiológico em malha fechada e utilizando informaçao fornecida pelo sistema nervoso autônomo (SNA). A medida da impedância cardíaca unipolar permite a monitorizaçao do estado de contraçao do coraçao, diretamente relacionado ao tônus simpático. Marcapassos uni ou bicamerais com sistemas responsivos controlados pelo SNA foram implantados em 262 pacientes em vários centros clínicos. Protocolos de exercícios clínicos, monitorizaçao por Holter, testes de estresse psicológico e estudos adicionais visando uma variaçao intencional do tônus simpático confirmaram a resposta fisiológica em freqüência para os vários tipos de mudanças hemodinâmicas

Estimulaçao com Adaptaçao de Freqüência Controlada pelo Sistema Nervoso Autônomo - Uma Avaliaçao Clínica

Para o tratamento da incompetência cronotrópica, marcapassos com adaptaçao em freqüência baseados em diferentes sinais de sensores têm sido desenvolvidos, visando restaurar o mecanismo fisiológico em malha fechada e utilizando informaçao fornecida pelo sistema nervoso autônomo (SNA). A medida da impedância cardíaca unipolar permite a monitorizaçao do estado de contraçao do coraçao, diretamente relacionado ao tônus simpático. Marcapassos uni ou bicamerais com sistemas responsivos controlados pelo SNA foram implantados em 262 pacientes em vários centros clínicos. Protocolos de exercícios clínicos, monitorizaçao por Holter, testes de estresse psicológico e estudos adicionais visando uma variaçao intencional do tônus simpático confirmaram a resposta fisiológica em freqüência para os vários tipos de mudanças hemodinâmicas

Comprehensive multicomponent cardiac rehabilitation in cardiac implantable electronic devices recipients: a consensus document from the European Association of Preventive Cardiology (EAPC; Secondary prevention and rehabilitation section) and European Heart Rhythm Association (EHRA)

Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2021Cardiac rehabilitation (CR) is a multidisciplinary intervention including patient assessment and medical actions to promote stabilization, management of cardiovascular risk factors, vocational support, psychosocial management, physical activity counselling, and prescription of exercise training. Millions of people with cardiac implantable electronic devices live in Europe and their numbers are progressively increasing, therefore, large subsets of patients admitted in CR facilities have a cardiac implantable electronic device. Patients who are cardiac implantable electronic devices recipients are considered eligible for a CR programme. This is not only related to the underlying heart disease but also to specific issues, such as psychological adaptation to living with an implanted device and, in implantable cardioverter-defibrillator patients, the risk of arrhythmia, syncope, and sudden cardiac death. Therefore, these patients should receive special attention, as their needs may differ from other patients participating in CR. As evidence from studies of CR in patients with cardiac implantable electronic devices is sparse, detailed clinical practice guidelines are lacking. Here, we aim to provide practical recommendations for CR in cardiac implantable electronic devices recipients in order to increase CR implementation, efficacy, and safety in this subset of patients.info:eu-repo/semantics/publishedVersio