Identifying barriers to effective cardiac rehabilitation

Announcing a new article publication for Cardiovascular Innovations and Applications journal. Cardiac rehabilitation (CR) typically consists of physical activity supplemented with lifestyle modifications, including smoking cessation, adherence to a healthy diet, stress management, medication adherence management, risk factor reduction, psychosocial support, and education.

Because CR involves important changes in lifestyle and physical activity, self-management is central to successful CR. Proper knowledge regarding, and attitudes toward, CR are key to effective self-management.

Consequently, identifying knowledge gaps, misconceptions, and misunderstandings regarding CR could improve attitudes and practice. This study examines CR knowledge, attitudes, and practice (KAP) among patients with HF and cardiology healthcare providers.

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Access to Care

Patient Compliance

Program Adherence

Psychosocial Barriers

Health Literacy

Socioeconomic Status

Cultural Beliefs

Healthcare Accessibility

Patient Motivation

Health Insurance Coverage

Transportation Issues

Work and Time Constraints

Language Barriers

Family Support

Awareness of Benefits

Why are heart attacks higher in younger women than men? PGI study has some answers

When a 32-year-old marketing executive walked into the emergency room of Fortis Hospital, Mohali, complaining of severe fatigue, mild chest discomfort and shortness of breath, she thought her blood pressure was fluctuating once again. As the staff decided to do a routine electrocardiogram (ECG), Dr Arun Kochar, additional director, cardiology, immediately ordered a troponin test, which indicates damage to the heart muscle. It showed she had already suffered a heart attack.

“Her symptoms were atypical as she did not have chest pain but her test results suggested acute myocardial infarction. An angiography revealed that she had severe blockage in major heart arteries. We had to do an emergency bypass surgery. Two years later, she is on a regular follow-up and her heart is functioning absolutely normally. Heart disease can affect any woman, regardless of age, even with the cardio-protective properties of estrogen in their reproductive years. A cocktail of smoking, alcohol, stress and birth control pills is the new trigger,” says Dr Kochar.

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Do you have chronic fatigue syndrome? Here’s how it impacts heart health  

Chronic Fatigue Syndrome (CFS), also known as myalgic encephalomyelitis (ME), is a complex and debilitating condition characterized by persistent fatigue that is not alleviated by rest and is accompanied by a range of other symptoms. While the exact cause of CFS remains unknown, it is believed to involve a combination of factors including viral infections, immune system dysfunction, hormonal imbalances, and genetic predisposition.

The ANS plays a crucial role in regulating various bodily functions, including heart rate, blood pressure, and digestion. In individuals with CFS, dysfunction of the ANS can lead to alterations in blood pressure control. This dysregulation can result in fluctuations in blood pressure, including both hypotension (low blood pressure) and hypertension (high blood pressure). These fluctuations can pose significant risks to heart health, as hypertension is a known risk factor for cardiovascular disease, including heart attacks and strokes.
Patients with Chronic Fatigue Syndrome have autonomic dysfunction which can lead to alterations in blood pressure control and creates a positive inflammatory state in the body. An increase in the oxidative stress leads to an increase in chances of having a Heart Attack, resistance to anti hypertensive medications & increase in incidence of arrhythmia like Atrial Fibrillation. Patients with chronic fatigue syndrome also tend to develop impaired glucose tolerance leading to metabolic syndrome. An early diagnosis and management of chronic fatigue syndrome helps in preventing long term life threatening complications.

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Early TAVR Benefits Patients with Asymptomatic Severe Aortic Stenosis

For patients with asymptomatic severe aortic stenosis (AS) and preserved left-ventricular ejection fraction, current guidelines recommend clinical surveillance every six to twelve months. It still remains unclear whether early transcatheter aortic valve replacement (TAVR) provides advantages over the guideline-recommended clinical surveillance. Now, the first powered randomized trial evaluating early intervention with TAVR in patients with asymptomatic severe AS has found that this strategy is both safe and effective compared to clinical surveillance.

The study conducted at the Gagnon Cardiovascular Institute (Morristown, NJ, USA) involved 1,578 patients who consented for screening at 75 centers in the United States and Canada from March 2017 through December 2021. Among them, 901 patients were randomized to receive either transfemoral TAVR or clinical surveillance. The mean age of participants was 76 years, with 69% being male, and the mean Society of Thoracic Surgeons risk score was 1.8%. Additionally, 84% of the patients were assessed as low surgical risk according to evaluations by local heart teams. Asymptomatic status was confirmed in over 90% of patients via negative treadmill stress tests, and the mean Kansas City Cardiomyopathy Questionnaire score at baseline was an excellent 92.7. The baseline echocardiographic characteristics were comparable between the two groups.

The primary endpoint of the study, which was a composite of death, stroke, or unplanned cardiovascular hospitalization, was assessed for superiority in the intent-to-treat population following a minimum follow-up of two years. The findings, published in the New England Journal of Medicine, indicated that early TAVR led to a significant reduction in the primary endpoint at two years, as well as during a median follow-up of 3.8 years, with incidences of 35.1% in the TAVR group compared to 51.2% in the surveillance group. Moreover, the secondary endpoint of favorable health status occurred more frequently in the early TAVR group (86.6%) than in the surveillance group (68%).

Additionally, left-ventricular and left-atrial health at the two-year mark was found to be superior in patients who underwent early TAVR. Changes in left-ventricular ejection fraction from baseline to two years, the onset of new atrial fibrillation, and rates of death or disabling stroke were similar between the two groups. Notably, by the two-year follow-up, over 70% of patients in the clinical surveillance group required aortic valve replacement (AVR), with most of them developing symptoms. The median time to conversion to AVR was 11.1 months, with 26% and 47% of patients needing AVR at six months and one year, respectively. Alarmingly, approximately 40% of patients in the clinical surveillance group exhibited acute and advanced symptoms, including NYHA class III-IV heart failure, pulmonary edema, or syncope.

“Given the benefits observed and the lack of harm, early TAVR may be preferred to clinical surveillance in patients with asymptomatic severe AS, especially when combined with the challenges of timely symptom recognition and prompt treatment in real-world settings,” said Philippe Généreux, MD, Director of the Structural Heart Program at the Gagnon Cardiovascular Institute. “Not only is early intervention safe and effective, but it also prevents a decline in quality of life for those who later receive TAVR and could prevent the development of cardiac damage.”

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Predicting Heart Failure with AI A New Era in Healthcare #pencis#cardiol...

           Predicting Heart Failure with AI A New Era in Healthcare

"Predicting Heart Failure with AI: A New Era in Healthcare" explores how artificial intelligence is transforming cardiovascular care by predicting heart failure risks with unparalleled accuracy. Leveraging vast datasets and machine learning algorithms, AI systems can analyze patient history, lifestyle factors, genetic predispositions, and real-time health data to identify patterns leading to heart failure. This predictive power enables early intervention, personalized treatment plans, and preventive measures, significantly improving patient outcomes and reducing healthcare costs. Embracing AI in cardiac care signals a promising future where proactive healthcare can save lives and create a healthier society.

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     Study shows high rates of unrecognized heart valve                                     disease in healthy seniors

The sheer scale of undiagnosed heart valve disease in our ageing population has been revealed for the first time, thanks to new research led by the University of East Anglia. 

More than a quarter of healthy and symptom-free over 60s examined in the study were found to have previously undetected heart valve disease. 

Co-lead author Vassilios Vassiliou, Clinical Professor of Cardiac Medicine at UEA's Norwich Medical School, said: "This study focused on understanding how widespread heart valve issues of any severity are among healthy, symptom-free adults without any known heart diseases. 

"We examined almost 4,500 individuals aged 60 and older from three regions in the UK: Norfolk, West Midlands, and Aberdeen, using echocardiography, which is an ultrasound of the heart. 

"Our findings showed that more than 28pc of these adults had some form of heart valve disease, although reassuringly it was only mild in the majority of the cases. 

"The data also indicated that age was the main factor associated with these heart valve problems, meaning that the older a person is, the higher their chance of having a significant valve issue." 

Blood flows around the heart and the rest of the body in one direction, like a one-way traffic system. 

The four heart valves (pulmonary and tricuspid on the right side, and aortic and mitral on the left side of the heart) control the direction of the blood flow ensuring optimal pumping of the heart.  

"These problems can put extra strain on the heart and make the heart work harder. Over time, it can increase the risk of having a heart attack, stroke and other heart conditions." 

Symptoms can include feeling breathless, chest pain, feeling weak or dizzy, swollen ankles and feet, feeling more tired than usual and chest or neck palpitations. 

Between 2007 and 2016, a total of 10,000 asymptomatic patients, over the age of 60, were invited through their general practices to take part in the study, which was funded by the British Heart Foundation. 

Of those, 5,429 volunteered to participate, of whom 4,237 were eligible for inclusion. 

They were evaluated with a health questionnaire, clinical examination and transthoracic echocardiography, which is an ultrasound of the heart. 

Heart valve disease was diagnosed in 28.2pc. The prevalence of clinically significant valvular heart disease was reassuringly only 2.4pc, with one in 42 of the over-60s found to have a moderate or severe case, rising to one in 15 for those aged 75 and older. 

However, only 21pc - 900 of the 4,237 patients evaluated - were 75 or over and only 8.6pc were over the age of 80. 

Prof Vassiliou said: "The diagnosis of heart valve disease mostly relies on transthoracic echocardiography, however this is normally only carried out if symptoms are reported or if an unusual murmur is heard during a physical examination. 

"This can be challenging in the elderly because mild symptoms may be masked by reduced physical activity and impaired mobility. 

"This study reveals that many older adults have heart valve issues, even if they don't show any symptoms and we would suggest that if people do develop any new symptoms or signs that could indicate heart disease to discuss this with their doctor. 

"As our population ages, this information can help healthcare providers understand the scale of valve disease and streamline routine care methods and screening programs to ensure that we can cope with the demand in the future. 

"This way, they can better identify and help those at risk before problems become serious." 

The researchers say further studies are needed to clarify the prevalence of the disease in the elderly population and how screening could be used to help identify and manage the disease. 

James Leiper, Associate Medical Director at the British Heart Foundation, said: "This important research using a very large group of people without symptoms showed that over a quarter of participants had a previously undetected heart valve condition. 

"Further research will be required to build on these strong foundations and develop methods to test the feasibility of disease identification in these individuals. 

"Whilst we have made strides, there is still more to be done to eradicate heart disease for good. It is essential that we keep funding lifesaving research, so fewer people have to go through heart break." 

The research also involved the Norfolk and Norwich University Hospital, Aberdeen Royal Infirmary, University of Aberdeen, University of Birmingham, the Royal Brompton Hospital, London, and Imperial College London. 

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• #SeniorHealth
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• #PreventativeHealth
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                             Fixing a leaky tricuspid valve

The heart's four valves open and shut in a carefully timed sequence to move blood through and out of the heart to the body. But the leaflets (flaps of tissue that make up the valves) and nearby structures don't always function as they should. Heart valve problems fall into two main categories:

Regurgitation (also known as leakage or insufficiency). The valve leaflets do not close properly, causing blood to flow backward each time the heart contracts.

Stenosis (narrowing). The valve leaflets become thick and stiff, so the valve doesn't open as wide as it should to allow blood to pass through.

Both problems can arise simultaneously in the same valve, and more than one valve may be affected. Malfunctioning heart valves can have serious consequences, potentially hampering the heart's ability to pump sufficient amounts blood throughout the body.

Once referred to as the forgotten valve, the tricuspid valve has been getting more attention of late. Earlier this year, the FDA approved two catheter-based devices for repairing a leaky tricuspid valve (see "Understanding heart valve disease"). Both devices have been shown to relieve symptoms and improve quality of life for people with moderate to severe tricuspid regurgitation, which affects about 4% of people ages 75 and older.

The two valves on the left side of the heart (the aortic and mitral valves) are more likely to develop problems than the tricuspid valve, which separates the upper-right and lower-right chambers of the heart. But that's just one reason that tricuspid valve problems have been underappreciated, says Dr. Pinak B. Shah, executive director of interventional and structural heart services at Harvard-affiliated Brigham and Women's Hospital. "People can have a lot of leakage from the tricuspid valve for a long period of time before they start showing any symptoms," he says.

Causes and symptoms

A range of issues can cause the tricuspid valve to malfunction, including inborn structural problems, heart infections, or conditions (most notably, longstanding atrial fibrillation) that cause the base of the valve to widen. When the valve leaks, blood can flow backward into the right atrium, causing the heart to pump harder. Over time, the heart enlarges and struggles to function normally.

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