4 research outputs found
Outcomes of Investigating T Wave Inversion With Echocardiography in an Unselected Young Male Preparticipation Cohort
BACKGROUND Electrocardiography (ECG) may be performed as part of preparticipation sports screening. Recommendations on screening of athletes to identify individuals with previously unrecognized cardiac disease are robust; however, data guiding the preparticipation screening of unselected populations are scarce. T wave inversion (TWI) on ECG may suggest an undiagnosed cardiomyopathy. This study aims to describe the prevalence of abnormal TWI in an unselected young male cohort and the outcomes of an echocardiographyâguided approach to investigating these individuals for structural heart diseases, focusing on the yield for cardiomyopathies. METHODS AND RESULTS Consecutive young male individuals undergoing a national preparticipation cardiac screening program for 39 months were studied. All underwent resting supine 12âlead ECG. Those manifesting abnormal TWI, defined as negatively deflected T waves of at least 0.1 mV amplitude in any 2 contiguous leads, underwent echocardiography. A total of 69â714 male individuals with a mean age of 17.9±1.1âyears were studied. Of the individuals, 562 (0.8%) displayed abnormal TWI. This was most frequently observed in the anterior territory and least so in the lateral territory. A total of 12 individuals (2.1%) were diagnosed with a cardiomyopathy. Cardiomyopathy diagnoses were significantly associated with deeper maximum TWI depth and the presence of abnormal TWI in the lateral territory, but not with abnormal TWI in the anterior and inferior territories. No individual presenting with TWI restricted to solely leads V1 to V2, 2 inferior leads or both was diagnosed with a cardiomyopathy. CONCLUSIONS Cardiomyopathy diagnoses were more strongly associated with certain patterns of abnormal TWI. Our findings may support decisions to prioritize echocardiography in these individuals
Prevalence and Associated Clinical Characteristics of Exercise-Induced ST-Segment Elevation in Lead aVR
Nature of cardiac rehabilitation around the globe
Abstract
Background: Cardiac rehabilitation (CR) is a clinically-effective but complex model of care. The purpose of this study was to characterize the nature of CR programs around the world, in relation to guideline recommendations, and compare this by World Health Organization (WHO) region.
Methods: In this cross-sectional study, a piloted survey was administered online to CR programs globally. Cardiac associations and local champions facilitated program identification. Quality (benchmark of â„ 75% of programs in a given country meeting each of 20 indicators) was ranked. Results were compared by WHO region using generalized linear mixed models.
Findings: 111/203 (54.7%) countries in the world offer CR; data were collected in 93 (83.8%; NâŻ=âŻ1082 surveys, 32.1% program response rate). The most commonly-accepted indications were: myocardial infarction (nâŻ=âŻ832, 97.4%), percutaneous coronary intervention (nâŻ=âŻ820, 96.1%; 0.10), and coronary artery bypass surgery (nâŻ=âŻ817, 95.8%). Most programs were led by physicians (nâŻ=âŻ680; 69.1%). The most common CR providers (meanâŻ=âŻ5.9âŻÂ±âŻ2.8/program) were: nurses (nâŻ=âŻ816, 88.1%; low in Africa, pâŻ<âŻ0.001), dietitians (nâŻ=âŻ739, 80.2%), and physiotherapists (nâŻ=âŻ733, 79.3%). The most commonly-offered core components (meanâŻ=âŻ8.7âŻÂ±âŻ1.9 program) were: initial assessment (nâŻ=âŻ939, 98.8%; most commonly for hypertension, tobacco, and physical inactivity), risk factor management (nâŻ=âŻ928, 98.2%), patient education (nâŻ=âŻ895, 96.9%), and exercise (nâŻ=âŻ898, 94.3%; lower in Western Pacific, pâŻ<âŻ0.01). All regions met â„ 16/20 quality indicators, but quality was < 75% for tobacco cessation and return-to-work counseling (lower in Americas, pâŻ=âŻ< 0.05).
Interpretation: This first-ever survey of CR around the globe suggests CR quality is high. However, there is significant regional variation, which could impact patient outcomes
Cardiac rehabilitation availability and density around the globe
Abstract
Background: Despite the epidemic of cardiovascular disease and the benefits of cardiac rehabilitation (CR), availability is known to be insufficient, although this is not quantified. This study ascertained CR availability, volumes and its drivers, and density.
Methods: A survey was administered to CR programs globally. Cardiac associations and local champions facilitated program identification. Factors associated with volumes were assessed using generalized linear mixed models, and compared by World Health Organization region. Density (i.e. annual ischemic heart disease [IHD] incidence estimate from Global Burden of Disease study divided by national CR capacity) was computed.
Findings: CR was available in 111/203 (54.7%) countries; data were collected in 93 (83.8% country response; NâŻ=âŻ1082 surveys, 32.1% program response rate). Availability by region ranged from 80.7% of countries in Europe, to 17.0% in Africa (pâŻ<âŻ0.001). There were 5753 programs globally that could serve 1,655,083 patients/year, despite an estimated 20,279,651 incident IHD cases globally/year. Volume was significantly greater where patients were systematically referred (odds ratio [OR]âŻ=âŻ1.36, 95% confidence interval [CI]âŻ=âŻ1.35â1.38) and programs offered alternative models (ORâŻ=âŻ1.05, 95%CIâŻ=âŻ1.04â1.06), and significantly lower with private (ORâŻ=âŻ0.92, 95%CIâŻ=âŻ0.91â0.93) or public (ORâŻ=âŻ0.83, 95%CIâŻ=âŻ0.82â0.84) funding compared to hybrid sources.
Median capacity (i.e., number of patients a program could serve annually) was 246/program (Q25âQ75âŻ=âŻ150â390). The absolute density was one CR spot per 11 IHD cases in countries with CR, and 12 globally.
Interpretation: CR is available in only half of countries globally. Where offered, capacity is grossly insufficient, such that most patients will not derive the benefits associated with participation