European Journal of Cardiovascular Prevention & Rehabilitation最新文献

{"title":"Hypertensives in Russia are interested in a healthier lifestyle: results of the RELIF multicenter study.","authors":"Rafael G Oganov,&nbsp;Goar-Nana V Pogosova,&nbsp;Igor E Koltunov,&nbsp;Victoria P Irdzevskaya,&nbsp;Olga Y Sokolova,&nbsp;Vladimir A Vigodin","doi":"10.1177/1741826710389360","DOIUrl":"https://doi.org/10.1177/1741826710389360","url":null,"abstract":"<p><strong>Background: </strong>There are several reasons for the gap between guidelines and routine practice of cardiovascular disease (CVD) prevention. Among these patient-related factors are interest and motivation for lifestyle modification.</p><p><strong>Design: </strong>The article represents a subgroup analysis of RELIF (REgularnoe Lechenie I proFilaktika) study conducted in 20 cities of Russia, where five polyclinics were selected randomly, with five general practitioners (GPs) in each. Each GP enrolled five consecutive hypertensive patients.</p><p><strong>Methods: </strong>Physicians and patients completed questionnaires concerning patients' medical history, risk factors (RF), health education, interest in lifestyle changes, recommendations and compliance. Patients also completed the Hospital Anxiety and Depression Scale (HADS). Statistical analysis was performed by variation statistics standard algorithm.</p><p><strong>Results: </strong>1078 patients were enrolled. The survey revealed a high prevalence of cardiovascular RF (e.g. hyperlipidemia in 64.23 per cent of patients, obesity in 43.97 per cent, smoking in 43.51 per cent of men) as well as of unhealthy food habits. Anxiety was seen in 55.4 per cent of patients and depressive symptoms in 44.8 per cent. A minority knew the cardiovascular RF: hypertension was listed by 22.4 per cent of men and 32.5 per cent of women; obesity by 18.3 per cent of men and 27.8 per cent of women; smoking by 34.9 per cent (men) and 14.9 per cent (women); and cholesterol by 3.3 per cent (men) and 7.7 per cent (women). Among both men and women, 30 per cent knew the limits of normal BP. Many patients (86 per cent) received information predominantly from GPs, and were not satisfied with it. A large number of patients (79.3 per cent) demonstrated various degree of readiness for lifestyle changes, and 30.62-48.8 per cent of patients were interested in additional education.</p><p><strong>Conclusions: </strong>The study demonstrates both high prevalence of RF in hypertensives in Russia, and low level of patient's knowledge on CVD-related issues. The high level of patients' motivation for lifestyle changes offers possibilities for future improvement.</p>","PeriodicalId":50492,"journal":{"name":"European Journal of Cardiovascular Prevention & Rehabilitation","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2011-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1741826710389360","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"29779935","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Asymptomatic peripheral arterial disease: is pharmacological prevention of cardiovascular risk cost-effective?","authors":"B Sigvant,&nbsp;M Henriksson,&nbsp;F Lundin,&nbsp;E Wahlberg","doi":"10.1177/1741826710389368","DOIUrl":"https://doi.org/10.1177/1741826710389368","url":null,"abstract":"<p><p>Peripheral arterial disease (PAD) is associated with an increased risk of early death in cardiovascular (CV) disease. The majority of PAD subjects are asymptomatic with a prevalence of 11 per cent among the elderly. Long-term drug prevention aiming to minimize disease progression and CV events in these subjects is probably beneficial, but expensive. The purpose of this analysis was to evaluate the cost-effectiveness of pharmacological risk reduction in subclinical PAD. Long-term costs and quality-adjusted life years (QALYs) were estimated by employing a decision-analytic model for ACE-inhibitor, statin, aspirin and non-aspirin anti-platelet therapy. Rates of CV events without treatment were derived from epidemiological studies and event rate reduction were retrieved from clinical trials. Costs and health-related quality of life estimates were obtained from published sources. All four drugs reduced CV events. Using ACE-inhibition resulted in a heart rate (HR) of 0.67 (95% CI: 0.55-0.79), statins 0.74 (0.70-0.79), and clopidogrel 0.72 (0.43-1.00). Aspirin had a HR of 0.87 and the 95% CI passed included one (0.72-1.03). ACE-inhibition was associated with the largest reduction in events leading to the highest gain in QALYs (7.95). Furthermore, ACE-inhibitors were associated with the lowest mean cost €40.556. In conclusion, while all drugs reduced CV events, ACE-inhibition was the most cost-effective. These results suggest that we should consider efforts to identify patients with asymptomatic PAD and, when identified, offer ACE-inhibition.</p>","PeriodicalId":50492,"journal":{"name":"European Journal of Cardiovascular Prevention & Rehabilitation","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2011-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1741826710389368","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"29779939","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Four-year follow-up of the Choice of Health Options In prevention of Cardiovascular Events randomized controlled trial.","authors":"Lis Neubeck,&nbsp;S B Freedman,&nbsp;Tom Briffa,&nbsp;Adrian Bauman,&nbsp;Julie Redfern","doi":"10.1097/HJR.0b013e32833cca66","DOIUrl":"https://doi.org/10.1097/HJR.0b013e32833cca66","url":null,"abstract":"<p><strong>Objective: </strong>To determine if the improved risk factor profile at 1 year attributed to the Choice of Health Options In prevention of Cardiovascular Events (CHOICE) program was maintained at 4 years.</p><p><strong>Design: </strong>Single-blind randomized controlled trial with post-hoc 476 months follow-up (76% complete).</p><p><strong>Setting: </strong>Australian tertiary referral hospital.</p><p><strong>Patients: </strong>Two hundred and eight acute coronary syndrome survivors.</p><p><strong>Interventions: </strong>Acute coronary syndrome survivors not accessing cardiac rehabilitation (CR) were randomized to control (n=72) or CHOICE (n=72) comprising the tailored risk factor reduction packaged as a clinic visit and 3 months phone support. A contemporary CR reference group were also recruited (n=64). Blinded risk assessment occurred at baseline, 1 and 4 years.</p><p><strong>Main outcome measures: </strong>Total cholesterol, systolic blood pressure, smoking status, physical activity.</p><p><strong>Results: </strong>One year improvements in all the modifiable risk factors achieved in CHOICE were maintained at 4 years. CHOICE and control were well-matched at baseline. At 4 years, there was a trend towards lower total cholesterol in CHOICE compared with controls (mean 4.0±0.1 vs. 4.2±0.1 mmol/l, P=0.05), significantly better systolic blood pressure (mean 132.2±2.1 vs. 136.8±2.0 mmHg, P=0.01), physical activity scores (1200±209 vs. 968±196 metabolic equivalent min/week, P=0.02) and proportion with three or more risk factors above national targets (20 vs. 42%,P=0.02). Participants in CHOICE were at higher baseline risk than CR but at 4 years they had similar risk factor profiles.</p><p><strong>Conclusion: </strong>Participants in CHOICE maintained favorable changes in coronary risk profile at 4 years compared with control, indicating that CHOICE is an effective long-term intervention among those not accessing facility-based CR.</p>","PeriodicalId":50492,"journal":{"name":"European Journal of Cardiovascular Prevention & Rehabilitation","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2011-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/HJR.0b013e32833cca66","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"29104553","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Beyond the blues: the need for integrated care pathways.","authors":"Chantal F Ski,&nbsp;David R Thompson","doi":"10.1177/1741826710389409","DOIUrl":"https://doi.org/10.1177/1741826710389409","url":null,"abstract":"Coronary heart disease (CHD) is a leading cause of morbidity and mortality and has significant human and economic consequences. Many people who survive have significant psychological distress, and diminished quality of life and failure to return to work or resume normal family and social roles are not uncommon. Increased attention has been focused on the role of depression, both as a predictor and a consequence of CHD, especially myocardial infarction. When depression is linked with CHD the outcome inevitably increases disease burden. The importance of early detection and early referral for treatment before hospital discharge may be an optimum moment along the care pathway.","PeriodicalId":50492,"journal":{"name":"European Journal of Cardiovascular Prevention & Rehabilitation","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2011-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1741826710389409","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"29779933","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Screening for depression in coronary heart disease: the perfect Hegelian dialectic? A short commentary on 'Beyond the blues: the need for integrated care pathways'.","authors":"Michael Jelinek","doi":"10.1177/1741826710389411","DOIUrl":"https://doi.org/10.1177/1741826710389411","url":null,"abstract":"Ski and Thompson state that there is a high prevalence of depression in patients with coronary heart disease (CHD) which ‘is associated with adverse outcomes, including increased morbidity and mortality and diminished quality of life in this population’. Thus they support the American Heart Association recommendation that screening programmes be set up to detect and treat depression in these patients with heart disease.","PeriodicalId":50492,"journal":{"name":"European Journal of Cardiovascular Prevention & Rehabilitation","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2011-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1741826710389411","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"29779934","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Arterial hypertension in obesity: relationships with hormone and anthropometric parameters.","authors":"Giovanni De Pergola,&nbsp;Adele Nardecchia,&nbsp;Pietro Guida,&nbsp;Franco Silvestris","doi":"10.1177/1741826710389367","DOIUrl":"https://doi.org/10.1177/1741826710389367","url":null,"abstract":"Background: Obesity has been recognized as an independent risk factor for arterial hypertension. Design: This study was addressed to identify parameters predictive of 24-h mean systolic and/or diastolic blood pressure levels in obesity. Methods: A cohort of 180 euthyroid overweight and obese patients, 79 women and 101 men, aged 20–63 years, normotensive (n = 62) or with recently developed hypertension (n = 118), and never treated with antihypertensive drugs, was examined. Waist circumference, fasting insulin, thyroid stimulating hormone (TSH), free thyroxine (FT) FT3, FT4, glucose, and lipid (cholesterol, high-density lipoprotein cholesterol and triglyceride) serum concentrations, and 24-h urinary aldosterone and catecholamines were measured. Ambulatory blood pressure monitoring (ABPM) was performed and hypertension was confirmed when 24-h mean systolic blood pressure was ≥125 mmHg and/or 24-h mean diastolic blood pressure was ≥80 mmHg, according to the 2007 European Society of Hypertension and European Society of Cardiology Practice Guidelines for the Management of Arterial Hypertension. Results: 24-h noradrenaline (p < 0.01) and adrenaline (p < 0.05) levels were higher in hypertensive than in normotensive subjects. The odds ratio (OR) was determined by several univariate and multivariate logistic regression analyses to evaluate the predictive factors of high 24-h blood pressure mean values. When subjects with high systolic and/or high diastolic blood pressure levels (n = 118) were compared to individuals with normal systolic and diastolic blood pressure levels (n = 62), multivariate analysis showed an independent association of hypertension with male gender and 24-h noradrenaline levels. When subjects with high systolic blood pressure levels (n = 108) were compared with those with normal systolic blood pressure levels (n = 72), multivariate analysis showed an independent association of high systolic blood pressure with noradrenaline levels. Lastly, when subjects with high diastolic blood pressure levels (n = 87) were compared with those with normal diastolic blood pressure levels (n = 93), multivariate analysis showed an independent negative association between high diastolic blood pressure and body mass index. Conclusions: the present study shows that diastolic blood pressure is independently and negatively associated with body mass index in normotensive or with recently discovered hypertension overweight and obese subjects, and never treated with antihypertensive drugs. These results suggest that obesity per se is responsible for a decrease in diastolic blood pressure before hypertensive state becomes stable. This study also confirms that male gender and daily noradrenaline production contribute to hypertension, and to higher systolic blood pressure levels in particular.","PeriodicalId":50492,"journal":{"name":"European Journal of Cardiovascular Prevention & Rehabilitation","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2011-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1741826710389367","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"29779937","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of a nationwide public campaign on delays and outcome in Swiss patients with acute coronary syndrome.","authors":"Barbara Naegeli,&nbsp;Dragana Radovanovic,&nbsp;Hans Rickli,&nbsp;Paul Erne,&nbsp;Burkhardt Seifert,&nbsp;Nicole Duvoisin,&nbsp;Giovanni Pedrazzini,&nbsp;Philip Urban,&nbsp;Osmund Bertel","doi":"10.1177/1741826710389386","DOIUrl":"https://doi.org/10.1177/1741826710389386","url":null,"abstract":"<p><strong>Background: </strong>To improve the outcome in patients with acute coronary syndrome (ACS), public campaigns have been launched aimed at shortening presentation delays and allowing more efficient treatment. Their impact is uncertain.</p><p><strong>Methods: </strong>Pre-hospital delays and outcome in patients with ACS included in the Swiss National AMIS Plus registry were assessed prospectively before and after a nationwide multimedia campaign ('HELP') by the Swiss Heart Foundation in 2007. The campaign aimed at better awareness of symptoms, increasing knowledge in laymen of resuscitation and more rapid access to medical services. The primary study endpoint was the time between onset of symptoms and hospital admission. Secondary endpoints were successful out-of-hospital resuscitation, symptoms upon admission, and outcome.</p><p><strong>Results: </strong>Between January 2005 and December 2008, 8906 ACS patients (61% ST-segment elevation myocardial infarction (STEMI), 39% non-ST-segment elevation myocardial infarction/unstable angina pectoris (NSTEMI/UAP), mean age 65 ± 13 years, 75% males) admitted within 24 hours after onset of symptoms were enrolled. The median pre-hospital delay was reduced from 197 minutes during the pre-intervention period to 180 minutes during the post-intervention period (reduction 10% (95% confidence interval (CI) 6-14%); P < 0.001), in STEMI (reduction 10% (95% CI 5-14%); P < 0.001) and NSTEMI patients (reduction 11% (95% CI 4-17%); P = 0.001), due to pronounced effects in males (reduction 12% (95% CI 7-16%); P < 0.001) and in patients ≤75 years (reduction 12% (95% CI 8-16%); P < 0.001). Out-of-hospital resuscitation increased (odds ratio (OR) 1.26 (95% CI 1.06-1.54); P = 0.02). Overall outcome remained unchanged, however, the rate of re-infarction showed a decrease (OR 0.58 (95% CI 0.36-0.91); P = 0.021).</p><p><strong>Conclusions: </strong>After a nationwide educational campaign, shorter pre-hospital delays were observed, and more patients were able to be treated promptly. These results may be useful in planning future health strategies to improve management and outcome of patients with ACS, especially in female and elderly patients.</p>","PeriodicalId":50492,"journal":{"name":"European Journal of Cardiovascular Prevention & Rehabilitation","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2011-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1741826710389386","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"29779841","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prehypertension and cardiovascular risk factors in adults enrolled in a primary care programme.","authors":"Aline B Nery,&nbsp;Evandro T Mesquita,&nbsp;Jocemir R Lugon,&nbsp;Hye Chung Kang,&nbsp;Veronica A de Miranda,&nbsp;Bernardo G T de Souza,&nbsp;Juliana A M Andrade,&nbsp;Maria Luiza G Rosa","doi":"10.1177/1741826710389380","DOIUrl":"https://doi.org/10.1177/1741826710389380","url":null,"abstract":"<p><strong>Background: </strong>An increase in cardiovascular (CV) disease has been observed in prehypertensive subjects who frequently carry other cardiovascular risk factors. In Brazil, little is known about prehypertension and its association with cardiovascular risk factors.</p><p><strong>Objective: </strong>To estimate the association between prehypertension and cardiovascular risk factors in a public primary healthcare programme.</p><p><strong>Methods: </strong>Associations in this cross-sectional study were estimated on the basis of generalized estimating equations. Results are expressed as odds ratio (OR) or adjusted odds ratio (OR(a)) with 95% confidence interval (CI).</p><p><strong>Results: </strong>The 357 participants were classified as normotensive (64.4%) or prehypertensive (35.6%). In a univariate analysis, prehypertension was statistically associated with male gender, age, table salt use, diabetes, body mass index (BMI), uric acid, and all lipids except high-density lipoprotein cholesterol. When analysis was performed adjusting for gender, age, and table salt use, the association of each metabolic parameter with prehypertension, remained significant for BMI (OR(a) = 1.097; 95% CI 1.035-1.162), triglycerides (OR(a) = 1.008; 95% CI 1.003-1.013), and uric acid (OR(a) = 1.269; 95% CI 1.023- .576). To check for their independence of obesity, associations of triglycerides and uric acid with prehypertension were reanalysed after adjustment for BMI. The association of triglycerides remained statistically significant. A trend of association was present for uric acid. The prevalence of prehypertension paralleled the increase of the number of risk factors.</p><p><strong>Conclusion: </strong>Prehypertension in Brazil is associated with well-recognized cardiovascular risk factors even in a continuously monitored population such the one under study. Prehypertension can be a valuable clue to alert health professionals to treat underlying perturbations to prevent overt cardiovascular disease.</p>","PeriodicalId":50492,"journal":{"name":"European Journal of Cardiovascular Prevention & Rehabilitation","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2011-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1741826710389380","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"29779936","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predicting CHD risk in France: a pooled analysis of the D.E.S.I.R., Three City, PRIME, and SU.VI.MAX studies.","authors":"J P Empana,&nbsp;M Tafflet,&nbsp;S Escolano,&nbsp;A C Vergnaux,&nbsp;S Bineau,&nbsp;J B Ruidavets,&nbsp;M Montaye,&nbsp;B Haas,&nbsp;S Czernichow,&nbsp;B Balkau,&nbsp;P Ducimetiere","doi":"10.1177/1741826710389354","DOIUrl":"https://doi.org/10.1177/1741826710389354","url":null,"abstract":"<p><strong>Background: </strong>We aimed to develop and validate a simple coronary heart disease (CHD) risk algorithm applicable to asymptomatic men and women in France, and to compare its accuracy with that of the last published version of the Framingham risk function for cardiovascular disease.</p><p><strong>Design: </strong>A pooled analysis of four French prospective general-population studies.</p><p><strong>Methods: </strong>The baseline and follow-up data from D.E.S.I.R., PRIME, Three City, and SU.VI.MAX studies were used. The 10-year CHD risk was estimated by the Cox proportional hazards model with candidate variables including age, gender, body mass index, waist circumference, family history of coronary heart disease, smoking status, diabetes status, systolic blood pressure, and total and high-density lipoprotein (HDL) cholesterol.</p><p><strong>Results: </strong>The study population included 22,256 subjects (61.4% men) aged (SD) 56.0 years (8.3) without a personal history of CHD at baseline. After a mean follow-up of 8.0 years (2.3), 788 first CHD events occurred, 726 in men and 62 in women. The final model included age, gender, age × gender interaction, current smoking status, diabetes status, systolic blood pressure, total and HDL cholesterol. Using this model, the number of predicted coronary events fitted that given by the 10-year Kaplan-Meier survival estimates within each decile of estimated risk (calibration). This model had fair discrimination: Harrell C-index, 0.7831 (95% CI: 0.7704-0.7957). For comparison, the recalibrated Framingham risk function had equivalent performances compared to the French risk equation.</p><p><strong>Conclusion: </strong>Our 10-year French CHD risk equation based on traditional risk factors performed at least as well as the recalibrated Framingham cardiovascular disease risk function.</p>","PeriodicalId":50492,"journal":{"name":"European Journal of Cardiovascular Prevention & Rehabilitation","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2011-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1741826710389354","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"29781522","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reconciling systematic reviews of exercise-based cardiac rehabilitation and secondary prevention programmes for coronary heart disease.","authors":"Michael Jelinek,&nbsp;Alexander M Clark,&nbsp;Neil B Oldridge,&nbsp;Thomas G Briffa,&nbsp;David R Thompson","doi":"10.1177/1741826710389388","DOIUrl":"https://doi.org/10.1177/1741826710389388","url":null,"abstract":"Findings of systematic reviews incorporating metaanalysis are by nature hypothesis generating and should be carefully and judiciously interpreted. This need is epitomized by two of the largest reviews of interventions to support risk factor reduction after a diagnosis of coronary heart disease (Table 1). These reviews both included randomized trials published in a similar timeframe (up to 2003 or 2004) that compared the effects of various risk factor reduction programmes for patients with confirmed coronary heart disease to usual care. In 2004, a Cochrane review found that supervised and unsupervised exercise-based cardiac rehabilitation provided to patients with different forms of coronary heart disease lowered all cause total mortality by 20% and cardiac mortality by 26% in 48 trials of 8940 patients. The reviewers concluded that there was ‘no difference in mortality effect between exercise-only cardiac rehabilitation and comprehensive cardiac rehabilitation, or by exercise dose or duration of followup’. Also, the exercise-based programmes did not reduce recurrent myocardial infarction and the need for repeat coronary revascularization to statistically significant levels. Around the same time, a second review of 63 trials involving 21,295 patients who had undergone secondary cardiac prevention programmes found reductions of total mortality of 15% and of acute myocardial infarction of 17%. However, in contrast to the previous review, the secondary prevention programmes significantly reduced the rate of recurrent heart attacks. Also, benefits did not differ between programmes ‘that incorporated education and counselling about coronary risk factors with a supervised exercise programme, those that included risk factor education or counselling but no exercise component, and those that consisted of only a structured exercise programme’. On first reading, these reviews appear to offer different conclusions on effects on cardiovascular morbidity and regarding the benefits of supervised exercise. Either could be cited selectively to support or refute the benefits of exercise programmes for morbidity or to support or refute the incorporation of supervised exercise into services. Why might these different conclusions have come about and how should they be interpreted? Firstly, it is unlikely that the different conclusions arise from differences in quality as both reviews were of high quality as defined by PRISMA criteria and included many of the same trials: 37 of the 48 (77%) exercise-based trials were included in the 63 (59%) secondary prevention trials. Rather, issues of statistical power can explain the differences noted in morbidity. The forest plot analyses showed that, although exercise-based programmes in the Cochrane review did not reach statistically significant headline ‘effect sizes’, there was a tendency towards reduced recurrent myocardial infarction and the need for repeat coronary revascularization. The larger review of secondary preventio","PeriodicalId":50492,"journal":{"name":"European Journal of Cardiovascular Prevention & Rehabilitation","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2011-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1741826710389388","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"29781519","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}