Efficacy of the Cardiac Rehabilitation Program in Patients with End-Stage Heart Failure, Heart Transplant Patients, and Left Ventricular Assist Device Recipients

Karapolat, Hale; Engin, Çağatay; Eroglu, Mehmet; Yağdı, Tahir; Zoghi, Mehdi; Nalbantgil, Sanem; Durmaz, Berrin; Kirazlı, Yeşim; Özbaran, Mustafa

doi:10.1016/j.transproceed.2013.06.009

Cited by 75 publications

(69 citation statements)

References 26 publications

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“…Cardiac rehabilitation (CR) can and should make an important contribution in this context (3,4). After being discharged from a CR center the patients should once more become able to autonomously manage the necessary tasks in their everyday lives back home.Over the last few years, several studies have emerged, most of them small, which report results following rehabilitation (5)(6)(7)(8)(9)(10)(11)(12)(13)(14). In these studies, physical performance at the end of CR was evaluated using different measuring techniques (functional independence measures [FIM], treadmill ergometry, bicycle ergometry, strength tests, and 6-min walk test [6MWT]).…”

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confidence: 99%

Exercise Capacity and Functional Performance in Heart Failure Patients Supported by a Left Ventricular Assist Device at Discharge From Inpatient Rehabilitation

et al. 2017

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Adequate physical and functional performance is an important prerequisite for renewed participation and integration in self-determined private and (where appropriate) professional lives following left ventricular assist device (LVAD) implantation. During cardiac rehabilitation (CR), individually adapted exercise programs aim to increase exercise capacity and functional performance. A retrospective analysis of cardiopulmonary exercise capacity and functional performance in LVAD patients at discharge from a cardiac rehabilitation program was conducted. The results from 68 LVAD patients (59 males, 9 females; 55.9 6 11.7 years; 47 HVAD, 2 MVAD, 15 HeartMate II, 4 HeartMate 3, and 4 different implanting centers) were included in the analysis. Exercise capacity was assessed using a cardiopulmonary exercise test on a bicycle ergometer (ramp protocol; 10 W/min). The 6-min walk test was used to determine functional performance. At discharge from CR (53 6 17 days after implantation), the mean peak work load achieved was 62.2 6 19.3 W (38% of predicted values) or 0.79 6 0.25 W/kg body weight. The mean cardiopulmonary exercise capacity (relative peak oxygen uptake) was 10.6 6 5.3 mL/kg/min (37% of predicted values). The 6-min walk distance improved significantly during CR (325 6 106 to 405 6 77 m; P < 0.01). No adverse events were documented during CR. The results show that, even following LVAD implantation, cardiopulmonary exercise capacity remains considerably restricted. In contrast, functional performance, measured by the 6-min walk distance, reaches an acceptable level. Light everyday tasks seem to be realistically surmountable for patients, making discharge from inpatient rehabilitation possible. Long-term monitoring is required in order to evaluate the situation and how it develops further. Key Words: Heart failure-Left ventricular assist deviceCardiac rehabilitation-Exercise capacity-Functional performance.In the last few years, left ventricular assist devices (LVADs) have been increasingly implanted as treatment for terminal heart failure (HF). Whereas initially these systems were only used as a bridge to transplantation (BTT), today approximately half of all recipients have them implanted as the ultimate destination therapy (DT) (1).The overriding therapeutic goal of LVAD implantation is to ensure patient survival and guarantee preservation of organ function (2). However, when patients become permanently dependent on the system, a return to everyday life and restoration of an acceptable quality of life acquire crucial significance. An optimum build-up of exercise capacity and adequate functional performance is therefore very significant. Cardiac rehabilitation (CR) can and should make an important contribution in this context (3,4). After being discharged from a CR center the patients should once more become able to autonomously manage the necessary tasks in their everyday lives back home.Over the last few years, several studies have emerged, most of them small, which report results following rehabilitat...

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Exercise Capacity and Functional Performance in Heart Failure Patients Supported by a Left Ventricular Assist Device at Discharge From Inpatient Rehabilitation

et al. 2017

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“…Уровень пикового VO 2 , равный 10,3 (9,(4)(5)(6)(7)(8)(9)(10)(11)6) мл/мин/кг и VE/VCO 2 slope, равный 42 (35-46), полу-ченные в нашем исследовании, свидетельствуют о плохом прогнозе заболевания и являются показа-нием для трансплантации сердца [11].…”

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“…Уро-вень качества жизни не только позволяет оценить субъективное восприятие пациентом эффективности проведенного лечения и возможности адаптации в социальной среде после операции, но и сам по себе имеет высокую предикторную ценность в отношении долгосрочной выживаемости [6,7]. Предполагается, что повышение толерантности к физической нагрузке после трансплантации сердца должно сопровож-даться повышением качества жизни.…”

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Factors of Life Quality Improvement After Heart Transplantation: Predictive Significance of Cardiopulmonary Exercise Test

et al. 2017

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Цель. Оценка прогностической значимости параметров кардиопульмональ-ного нагрузочного теста в улучшении качества жизни пациентов после транс-плантации сердца. Материал и методы. В исследование включены сорок пациентов с выражен-ной хронической сердечной недостаточностью (ХСН), включенные в лист ожидания трансплантации сердца. До операции и после ортотопической трансплантации сердца (ОТС) оценивали клинический статус, параметры кар-диопульмонального нагрузочного тестирования (КПНТ), качество жизни по результатам опросника sF-36. Результаты. После ОТС отмечено достоверное повышение качества жизни по шкале "Физический компонент здоровья" с 36 (32-45) баллов до операции до 52 (49-55) баллов (p<0,05) и по шкале "Психологический компонент здо-ровья" с 38 (34-50) до 51 (50-56) баллов. В 13% случаев повышения качества жизни не зарегистрировано. Среди параметров КПНТ значимую связь с повы-шением качества жизни по шкале "Физический компонент здоровья" показали предоперационный уровень толерантности к физической нагрузке (ОШ 2,10 (1,08-9,80), p=0,001), пиковое потребление кислорода (ОШ 1,20 (0,97-2,61), p=0,037), эффективность легочной вентиляции при нагрузке (ОШ 0,68 (0,36-1,27), p=0,047). Кроме того, показано, что повышение качества жизни после ОТС зависит от эффективности восстановления потребления кислорода за первую минуту (ОШ 1,13 (1,02-1,27), p=0,024). Связи параметров КПНТ с качеством жизни по шкале "Психологический компонент здоровья" опрос-ника sF-36 не отмечено. Заключение. Толерантность к физической нагрузке, пиковое потребление кислорода, эффективность легочной вентиляции при нагрузке, эффектив-ность восстановления потребления кислорода после физической нагрузки, определенные по данным КПНТ у пациентов с выраженной ХСН, имеют высо-кую предикторную ценность в оценке вероятности повышения качества жизни по шкале "Физический компонент здоровья" опросника sF-36 после транс-плантации сердца. BtPs -body temperature and pressure, saturated, NYHA -New York Heart Association, О 2 пульс -кислородный пульс, sF-36 -short Form 36, stPDstandard temperature and pressure, dry, Т 1/2 VO 2 -время полувосстановления пикового потребления кислорода, VE -минутная вентиляция легких, VE/ VCO 2 -вентиляторный эквивалент по углекислому газу, VE/VO 2 -вентилятор-ный эквивалент по кислороду, VO 2 -потребление кислорода, ДИ -довери-тельный интервал, КПНТ -кардиопульмональный нагрузочный тест, ЛЖ -левый желудочек, ОТС -ортотопическая трансплантация сердца, ОШ -отно-шение шансов, ФВ -фракция выброса, ФК -функциональный класс, ХСН -хроническая сердечная недостаточность, ЧСС -частота сердечных сокращений. Aim. Evaluation of prognostic significance of the parameters of cardiopulmonary exercise test in life quality improvement for the post-cardiac transplantation patients. Material and methods. Into the study, 40 patients included, with severe chronic heart failure (CHF), included in the waiting list for cardiac transplantation. Before and after orthotopic heart transplantation (OHt), clinical status was evaluated, cardiopulmonary exercise test...

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“…There are indications that patients who undergo, post-LVAD implantation, a course of treatment including psycho-education, re-education in physical activity and self-care, as well as psychological support to the patient and caregiver, show greater functional improvement in depression [234][235][236][237][238][239], in maintenance of a correct diet and in maintenance of adequate physical activity [240].…”

Section: Psychological Interventionsmentioning

confidence: 99%

Best practice in psychological activities in cardiovascular prevention and rehabilitation: Position Paper

Angelino

Porta

Abatello

et al. 2018

Monaldi Arch Chest Dis

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Recent guidelines on cardiovascular disease prevention suggest multimodal behavioral interventions for psychosocial risk factors and referral for psychotherapy in the case of clinically significant symptoms of depression and anxiety overall. Accordingly, psychologists of the Italian Association for Cardiovascular Prevention, Rehabilitation and Epidemiology (GICR-IACPR) have reviewed the key components of psychological activities in cardiovascular prevention and rehabilitation (CPR). The aim of this study was to elaborate a position paper on the best practice in routine psychological activities in CPR based on efficacy, effectiveness and sustainability. The steps followed were: i) a review of the latest international guidelines and position papers; ii) analysis of the evidence-based literature; iii) a qualitative analysis of the psychological services operating in some reference Italian cardiac rehabilitation facilities; iv) classification of the psychological activities in CPR as low or high intensity based on the NICE Guidelines on psychological interventions on anxiety and depression. We confirm the existence of an association between depression, anxiety, social factors, stress, personality and illness onset/outcome and coronary heart disease. Evidence for an association between depression, social factors and disease outcome emerges particularly for chronic heart failure. Some positive psychological variables (e.g., optimism) are associated to illness outcome. Evidence is reported on the impact of psychological activities on 'new' conditions which are now indicated for cardiac rehabilitation: pulmonary hypertension, grown-up congenital heart, end-stage heart failure, implantable cardioverter-defribrillator and mechanical ventricular assist devices, frail and oldest-old patients, and end-of-life care. We also report evidence related to caregivers. The Panel divided evidence-based psychological interventions into: i) low intensity (counseling, psycho-education, self-care, self-management, telemedicine, self-help); or ii) high intensity (individual, couples and/or family and group psychotherapy, such as stress management). The results show that psychotherapy is mainly consisting of cognitive-behavior therapy, interpersonal therapy, and short-term psycho-dynamic therapy. The current data further refine the working tools available for psychological activities in CPR, giving clear directions about the choice of interventions, which should be evidence-based and have at least a minimum standard. This document provides a comprehensive update on new knowledge and new paths for psychologists working in the CPR settings.

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Efficacy of the Cardiac Rehabilitation Program in Patients with End-Stage Heart Failure, Heart Transplant Patients, and Left Ventricular Assist Device Recipients

Cited by 75 publications

References 26 publications

Exercise Capacity and Functional Performance in Heart Failure Patients Supported by a Left Ventricular Assist Device at Discharge From Inpatient Rehabilitation

Exercise Capacity and Functional Performance in Heart Failure Patients Supported by a Left Ventricular Assist Device at Discharge From Inpatient Rehabilitation

Factors of Life Quality Improvement After Heart Transplantation: Predictive Significance of Cardiopulmonary Exercise Test

Best practice in psychological activities in cardiovascular prevention and rehabilitation: Position Paper

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