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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