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Recent Innovations in the Management of Cardiac Rehabilitation
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Recent Innovations in the Management of Cardiac Rehabilitation

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Clinical Rehabilitation".

Deadline for manuscript submissions: closed (30 April 2024) | Viewed by 6305

Special Issue Editor

Dr. Bruno Bordoni

E-Mail Website
Guest Editor
Department of Cardiology, Foundation Don Carlo Gnocchi IRCCS, Institute of Hospitalization and Care, S Maria Nascente, Via Capecelatro 66, 20100 Milan, Italy
Interests: diaphragm; fascia; cardiac rehabilitation; physiotherapy; osteopathic medicine

Special Issue Information

Dear Colleagues,

Cardiac rehabilitation is a fundamental path for a cardiac patient. The objectives of rehabilitation look at the whole person, putting the patient under the lenses of different professional figures: cardiologists, physiotherapists, speech therapists, psychologists, dieticians, osteopaths, and nurses. The type of patient undergoing the rehabilitation process does not respond to a single clinical description, but is extremely heterogeneous; hence, there is the real difficulty of correctly framing the rehabilitation process, which should always be subjective and non-standardized. Rehabilitation encompasses multiple cardiovascular pathologies and dysfunctions: patients who have suffered a myocardial infarction, patients undergoing PTCA and stenting, bypass, valve, and aortic replacements, heart transplantation, permanent or temporary L-VAD implantation, and chronic as well as acute CHF. Heart patients can present with pathologies involving multiple organs, or to prolong life as much as possible. The studies present in the literature take into consideration patients with specific criticalities in order to make the results non-confounding. The problem, however, is that, in rehabilitation wards and hospitalizations, the patient does not necessarily reflect a perfect clinical picture and does not always reflect the type of patient in the various trials. The clinician does not choose which patients to follow, without respecting the inclusion and exclusion criteria of an experimental study. Furthermore, the trials are a synthesis of a small portion of patients compared to the millions of cardiovascular patients; that is, each study is a snapshot of people chosen on the basis of specific statistical criteria. The reality of rehabilitation does not always reflect this picture. The Special Issue "Recent Innovations in the Management of Cardiac Rehabilitation" aims to highlight not only the results of the most recent research, but to highlight further rehabilitation possibilities with respect to the cardiovascular clinical reality through multidisciplinary perspectives.

Dr. Bruno Bordoni
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • endurance and resistance training
  • thoracic pain
  • respiratory muscles
  • multidisciplinary approach
  • L-VAD
  • myocardial infarction
  • cardiosurgery

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Published Papers (4 papers)

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Research

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9 pages, 555 KiB  
Article
Safety and Feasibility of Neuromuscular Electrical Stimulation in Patients with Extracorporeal Membrane Oxygenation
by Christos Kourek, Vasiliki Raidou, Michael Antonopoulos, Maria Dimopoulou, Antigone Koliopoulou, Eleftherios Karatzanos, Theodoros Pitsolis, Konstantinos Ieromonachos, Serafim Nanas, Stamatis Adamopoulos, Themistocles Chamogeorgakis and Stavros Dimopoulos
J. Clin. Med. 2024, 13(13), 3723; https://doi.org/10.3390/jcm13133723 - 26 Jun 2024
Viewed by 1335
Abstract
Background/Objectives: The aim of this study was to investigate the feasibility and safety of neuromuscular electrical stimulation (NMES) in patients on extracorporeal membrane oxygenation (ECMO) and thoroughly assess any potential adverse events. Methods: We conducted a prospective observational study assessing safety [...] Read more.
Background/Objectives: The aim of this study was to investigate the feasibility and safety of neuromuscular electrical stimulation (NMES) in patients on extracorporeal membrane oxygenation (ECMO) and thoroughly assess any potential adverse events. Methods: We conducted a prospective observational study assessing safety and feasibility, including 16 ICU patients on ECMO support who were admitted to the cardiac surgery ICU from January 2022 to December 2023. The majority of patients were females (63%) on veno-arterial (VA)-ECMO (81%), while the main cause was cardiogenic shock (81%) compared to respiratory failure. Patients underwent a 45 min NMES session while on ECMO support that included a warm-up phase of 5 min, a main phase of 35 min, and a recovery phase of 5 min. NMES was implemented on vastus lateralis, vastus medialis, gastrocnemius, and peroneus longus muscles of both lower extremities. Two stimulators delivered biphasic, symmetric impulses of 75 Hz, with a 400 μsec pulse duration, 5 sec on (1.6 sec ramp up and 0.8 sec ramp down) and 21 sec off. The intensity levels aimed to cause visible contractions and be well tolerated. Primary outcomes of this study were feasibility and safety, evaluated by whether NMES sessions were successfully achieved, and by any adverse events and complications. Secondary outcomes included indices of rhabdomyolysis from biochemical blood tests 24 h after the application of NMES. Results: All patients successfully completed their NMES session, with no adverse events or complications. The majority of patients achieved type 4 and 5 qualities of muscle contraction. Conclusions: NMES is a safe and feasible exercise methodology for patients supported with ECMO. Full article
(This article belongs to the Special Issue Recent Innovations in the Management of Cardiac Rehabilitation)
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12 pages, 247 KiB  
Article
Evaluation of Change in Body Composition, including Phase Angle, in Post-Myocardial Infarction Patients Rehabilitated under the KOS-Zawał (MC-AMI) Programme
by Aleksandra Ślązak, Iga Przybylska and Małgorzata Paprocka-Borowicz
J. Clin. Med. 2024, 13(10), 2784; https://doi.org/10.3390/jcm13102784 - 9 May 2024
Cited by 1 | Viewed by 1061
Abstract
Background: Ischaemic heart disease, including myocardial infarction, is one of the main causes leading to heart failure as a consequence of ischaemic myocardial damage. In recent years, survival in the acute phase of myocardial infarction has improved significantly, but the high mortality rate [...] Read more.
Background: Ischaemic heart disease, including myocardial infarction, is one of the main causes leading to heart failure as a consequence of ischaemic myocardial damage. In recent years, survival in the acute phase of myocardial infarction has improved significantly, but the high mortality rate within 12 months of hospital discharge (reaching up to 9.8% in Poland) remains a challenge. Therefore, the KOS-Zawał (MC-AMI) comprehensive 12-month post-MI care programme was introduced in Poland in 2017. Aim: This study aimed to assess body composition (including, but not limited to, the phase angle, visceral fat, total body fat, redistribution between intracellular and extracellular fluid in the body, and metabolic age) using a bioelectrical impedance analysis (BIA) in post-MI patients before and after early post-MI rehabilitation who were participating in the KOS-Zawał (MC-AMI) programme. Methods: This study involved an examination (before rehabilitation) of 94 post-myocardial infarction patients who were referred to a cardiology appointment within 7–10 days of hospital discharge, during which a clinical assessment, electrocardiogram, and biochemical blood tests (complete blood count, CRP, and serum creatinine) were performed. For various reasons (death, qualification for device implantation, non-completion of rehabilitation, failure to attend a follow-up BIA), data from 55 patients who were examined twice (before and after rehabilitation) were used for the final analysis. Measurements were taken using a high-grade Tanita MC-780 BIA body composition analyser, which measured the resistance of tissues to a low-intensity electrical impulse (not perceptible to the subject). Results: Participation in rehabilitation as part of the KOS-Zawał (MC-AMI) programme was associated with a decrease in metabolic age in patients, with a reduction in visceral fat levels and levels of adipose tissue in the lower and upper limbs. Moreover, a clinically beneficial reduction in the ratio of extracellular water to total body water was also observed. These changes were statistically significant (p < 0.005). In contrast, there were no statistically significant differences in the change in phase angle values in the subjects before and after the 5-week post-infarction rehabilitation. Conclusions: Participation in early post-myocardial infarction rehabilitation as part of the KOS-Zawał (MC-AMI) programme (25 training sessions) is associated with significant improvements in body composition parameters, such as visceral adipose tissue, limb fat, and water redistribution, and, consequently, a reduction in metabolic age, despite no significant increase in phase angle values. It was hypothesised that the good baseline condition of the subjects might explain the lack of significant change in the phase angle over the short observation period. For further analysis, it would be worthwhile to increase the number of patients with baseline reduced phase angle values and monitor changes in this parameter throughout rehabilitation and the entire MC-AMI programme, because changes in the phase angle may also be influenced by other programme components such as dietary or psychological education. It is worth considering implementing a regular BIA assessment in patients in the programme as a motivating stimulus for diligent exercise and extending rehabilitation to be followed by telerehabilitation or hybrid telerehabilitation. Full article
(This article belongs to the Special Issue Recent Innovations in the Management of Cardiac Rehabilitation)
14 pages, 1404 KiB  
Article
Cardiac Rehabilitation Increases Plasma Klotho Levels
by Ana María Pello Lázaro, Koldo Villelabeitia Jaureguizar, Juan Antonio Franco Peláez, Ana Venegas-Rodriguez, Álvaro Aceña, Andrea Kallmeyer, Ester Cánovas, María Luisa González-Casaus, Nieves Tarín, Carmen Cristóbal, Carlos Gutiérrez-Landaluce, Ana Huelmos, Óscar González-Lorenzo, Joaquín Alonso, Lorenzo López-Bescós, Jesús Egido, Ignacio Mahillo-Fernández, Jairo Lumpuy-Castillo, Óscar Lorenzo and José Tuñón
J. Clin. Med. 2024, 13(6), 1664; https://doi.org/10.3390/jcm13061664 - 14 Mar 2024
Viewed by 1430
Abstract
Background: Mineral metabolism (MM), mainly fibroblast growth factor-23 (FGF-23) and klotho, has been linked to cardiovascular (CV) diseases. Cardiac rehabilitation (CR) has been demonstrated to reduce CV events, although its potential relationship with changes in MM is unknown. Methods: We performed [...] Read more.
Background: Mineral metabolism (MM), mainly fibroblast growth factor-23 (FGF-23) and klotho, has been linked to cardiovascular (CV) diseases. Cardiac rehabilitation (CR) has been demonstrated to reduce CV events, although its potential relationship with changes in MM is unknown. Methods: We performed a prospective, observational, case-control study, with acute coronary syndrome (ACS) patients who underwent CR and control patients (matched by age, gender, left ventricular ejection fraction, diabetes, and coronary artery bypass grafting), who did not. The inclusion dates were from August 2013 to November 2017 in CR group and from July 2006 to June 2014 in control group. Clinical, biochemical, and MM biomarkers were collected at discharge and six months later. Our objective was to evaluate differences in the modification pattern of MM in both groups. Results: We included 58 CR patients and 116 controls. The control group showed a higher prevalence of hypertension (50.9% vs. 34.5%), ST-elevated myocardial infarction (59.5% vs. 29.3%), and treatment with angiotensin-converting enzyme inhibitors (100% vs. 69%). P2Y12 inhibitors and beta-blockers were more frequently prescribed in the CR group (83.6% vs. 96.6% and 82.8% vs. 94.8%, respectively). After six months, klotho levels increased in CR patients whereas they were reduced in controls (+63 vs. −49 pg/mL; p < 0.001). FGF-23 was unchanged in the CR group and reduced in controls (+0.2 vs. −17.3 RU/dL; p < 0.003). After multivariate analysis, only the change in klotho levels was significantly different between groups (+124 pg/mL favoring CR group; IC 95% [+44 to +205]; p = 0.003). Conclusions: In our study, CR after ACS increases plasma klotho levels without significant changes in other components of MM. Further studies are needed to clarify whether this effect has a causal role in the clinical benefit of CR. Full article
(This article belongs to the Special Issue Recent Innovations in the Management of Cardiac Rehabilitation)
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Review

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15 pages, 2569 KiB  
Review
A Scoping Review of Measurement Tools Evaluating Awareness and Disease-Related Knowledge in Peripheral Arterial Disease Patients
by Carolina Machado de Melo Felix, Danielle Aparecida Gomes Pereira, Maureen Pakosh, Lilian Pinto da Silva and Gabriela Lima de Melo Ghisi
J. Clin. Med. 2024, 13(1), 107; https://doi.org/10.3390/jcm13010107 - 24 Dec 2023
Cited by 1 | Viewed by 1492
Abstract
Background: Peripheral arterial disease (PAD) is the third leading cause of atherosclerotic cardiovascular morbidity worldwide, with high prevalence and associated complications, and is often overlooked and undertreated. Research has shown that there is a profound lack of PAD-related knowledge and awareness; additionally, information [...] Read more.
Background: Peripheral arterial disease (PAD) is the third leading cause of atherosclerotic cardiovascular morbidity worldwide, with high prevalence and associated complications, and is often overlooked and undertreated. Research has shown that there is a profound lack of PAD-related knowledge and awareness; additionally, information sources are not often reliable and accessible. The objective of this scoping review was: (1) to identify and critically appraise instruments that measure patients’ disease-related knowledge/awareness about PAD, and (2) to characterize the current state of knowledge/awareness levels among these patients. Methods: This systematic review was conducted and reported in accordance with the PRISMA statement. Six databases (APA PsycInfo, CINAHL Ultimate, Embase, Emcare Nursing, Medline ALL and Web of Science Core Collection) were searched, and search strategies were developed utilizing the PICO framework. Potential studies of any methodological design were considered for inclusion through a snowball hand search. Data from the included articles were extracted by a reviewer, and the extraction accuracy was independently cross-checked by another author. Results: The initial database search yielded 9832 records, of which sixteen studies (thirteen quantitative and three qualitative) were included. Only three questionnaires had their psychometric properties assessed. Questionnaire items focused on the following topics: definition/characteristics, risk factors/causes, treatment, complications, and personal issues regarding the perception/management of the disease. Overall, knowledge/awareness about PAD was low among patients. Conclusions: This study identified major gaps in PAD education, including the lack of availability of a validated measurement tool addressing all educational topics relevant to care and low knowledge/awareness of patients about their condition. Full article
(This article belongs to the Special Issue Recent Innovations in the Management of Cardiac Rehabilitation)
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