Variables Measured During Cardiopulmonary Exercise Testing as Predictors of Mortality in Chronic Systolic Heart Failure.

Background: Data from a cardiopulmonary exercise (CPX) test are used to determine prognosis in patients with chronic heart failure (HF). However, few published studies have simultaneously compared the relative prognostic strength of multiple CPX variables.

Objectives: The study sought to describe the strength of the association among variables measured during a CPX test and all-cause mortality in patients with HF with reduced ejection fraction (HFrEF), including the influence of sex and patient effort, as measured by respiratory exchange ratio (RER).

Religiosity and Spirituality During Cardiac Rehabilitation: A LONGITUDINAL EVALUATION OF PATIENT-REPORTED OUTCOMES AND EXERCISE CAPACITY.

Purpose: This study is a longitudinal evaluation of religiosity/spirituality (R/S) and religious coping in post-myocardial infarction and post-coronary artery bypass surgery patients during a 12-week cardiac rehabilitation program. This study examines change in R/S and the relationship between R/S and psychosocial outcomes and exercise capacity over time.

Methods: Cardiac rehabilitation patients (N = 105) completed measures of R/S, religious coping, quality of life (QOL), self-efficacy (SE), and energy expenditure (EE) at the beginning (baseline) and end of a 12-week program.

Relationships between changes in patient-reported health status and functional capacity in outpatients with heart failure.

Background: Heart failure trials use a variety of measures of functional capacity and quality of life. Lack of formal assessments of the relationships between changes in multiple aspects of patient-reported health status and measures of functional capacity over time limits the ability to compare results across studies.

Methods: Using data from HF-ACTION (N = 2331), we used the Pearson correlation coefficients and predicted change scores from linear mixed-effects modeling to demonstrate the associations between changes in patient-reported health status measured with the EQ-5D visual analog scale and the Kansas City Cardiomyopathy Questionnaire (KCCQ) and changes in peak VO(2) and 6-minute walk distance at 3 and 12 months.

Treatment of patients with intermediate cardiovascular risk: Are clinical measures enough?

Aim: Clinical measures of cardiovascular disease risk (CVD) are important tools for establishing therapy to lower CVD risk. Risk assessment has come under criticism because clinical measures can underestimate or overestimate CVD risk. We assessed CVD risk in 252 subjects without evidence of CVD to establish therapy of one or more risk factors from clinical indications.

Demographic differences in religious coping after a first-time cardiac event.

Purpose: The purpose of this project was to describe demographic characteristics of patients who may use religion as a coping response to a first-time cardiac event.

Methods: Patients (N = 105), who were enrolled in cardiac rehabilitation after a first-time myocardial infarction or coronary artery revascularization bypass surgery, completed the Religious Coping Activities Scale. Independent variables included age, gender, religious affiliation, diagnosis, marital status, and education level.

Reducing cardiovascular disease risk in medically underserved urban and rural communities.

Objectives: The aim of this study is to evaluate methods for lowering cardiovascular disease (CVD) risk in asymptomatic urban and rural underserved subjects.

Background: Medically underserved populations are at increased CVD risk, and systems to lower CVD risk are needed. Nurse management (NM) and telemedicine (T) systems may provide low-cost solutions for this care.

Clinical and functional predictors of health-related quality of life during cardiac rehabilitation.

Purpose: This is a retrospective and descriptive analysis of demographic and clinical factors common among cardiac rehabilitation patients with high versus low perceptions of health-related quality of life(HRQOL). In addition, we describe the characteristics that are predictive of greater improvements in HRQOL during cardiac rehabilitation.

Methods: We included 970 patients (63.

Rural and urban characteristics impact cardiovascular risk reduction.

Purpose: Our aim was to provide a descriptive analysis of specific differences between rural and urban residents and the interaction between these differences and those who reduced cardiovascular disease (CVD) risk in response to intervention versus those who did not.

Methods: This study is a descriptive analysis comparing rural groups with urban groups and those who decreased CVD risk with those who did not. Two hundred five rural (median age = 64.

Accuracy of blood pressure measurements transmitted through a telemedicine system in underserved populations.

In underserved populations, inadequate surveillance and treatment allows hypertension to persist until actual cardiovascular events occur. Thus, we developed an Internet-based telemedicine system to address the suboptimal control of hypertension and other modifiable risk factors. To minimize cost, the subjects used home monitors for blood pressure (BP) measurements and entered these values into the telemedicine system.

Using a telemedicine system to decrease cardiovascular disease risk in an underserved population: design, use, and interim results.

Cardiovascular disease is the leading cause of morbidity and mortality in the USA. Disease management programs, while successful, are intensive and expensive. Follow-up is often inadequate, incomplete, and inconsistent.

Cardiac rehabilitation outcomes no different after on-pump versus off-pump coronary artery bypass surgery.

Purpose: Clinical evidence supports lower morbidity with off-pump coronary revascularization surgery as well as superior short- and mid-term outcomes, equivalent graft patency, and reduced cost. The purpose of this study was to compare cardiac rehabilitation (CR) outcomes between patients undergoing on-pump versus off-pump coronary artery bypass surgery.

Methods: Data were retrospectively examined for patients who participated in CR between 1996 and 2004.

Cardiovascular disease prevention for underserved patients using the Internet: bridging the digital divide.

For underserved populations, telemedicine can address the high prevalence and suboptimal control of cardiovascular disease (CVD) risk factors. However, Internet access issues may limit the successful application of telemedicine. We tested the hypothesis that computer skills, and not access per se, was the main obstacle to using the Internet for health care.

Ventilatory markers during exercise for congestive heart failure.

The exaggerated ventilatory response in patients with heart failure is clearly multifactorial and complex beyond a mere reduction in pulmonary blood flow. Pulmonary dysfunction, including ventilation-perfusion mismatching, decreased lung compliance, restriction, airway obstruction, decreased diffusion capacity, and decreases in respiratory muscle strength and endurance, contributes to an inefficient breathing pattern and increased work of breathing. This is further compounded by the limited ability of the failing heart to meet the metabolic demands of the respiratory muscles, leading to underperfusion and ischemia.

Clinical predictors of 30-day cardiac events in patients with acute coronary syndrome at a community hospital.

Objective: We sought to determine predictors of coronary events (cardiac death, acute myocardial infarction, and urgent revascularization) within 30 days after admission.

Methods: We prospectively collected data on 400 patients admitted through our emergency room for unstable angina and acute coronary syndromes. Patients with ST-segment elevation myocardial infarction and those who required thrombolysis were excluded.

Quality of life and self-efficacy: gender and diagnoses considerations for management during cardiac rehabilitation.

Purpose: Outcome measurement research has extended beyond traditional clinical and physiologic parameters to include psychosocial aspects. Accordingly, the purpose of this study was to investigate quality-of-life (QOL) and self-efficacy disparities for gender and diagnoses during participation in cardiac rehabilitation.

Methods: For this study, 472 patients (114 women and 358 men) were stratified by gender and then again by diagnosis to include surgical revascularization, myocardial infarction, and percutaneous coronary intervention.

Exercise training for heart failure patients improves respiratory muscle endurance, exercise tolerance, breathlessness, and quality of life.

Purpose: Increased respiratory muscle endurance and peak oxygen consumption (VO(2peak)) induced by respiratory muscle training support the relationship between respiratory muscle function and exercise capacity in patients with heart failure. This raises the question whether exercise-training results in increased respiratory muscle function contributing to an increased exercise tolerance, a decreased perception of breathlessness, and an improved quality of life.

Methods: Prospective cohort analysis was completed on 24 patients with New York Heart Association (NYHA) Class III heart failure [18 men, 6 women; aged = 64 (SD 7.

Coronary artery "pseudothrombus" due to collateral flow artifact distal to left circumflex coronary stenosis.

Since the complexity, morbidity, and costs of coronary interventions are increased when coronary thrombus is present, identification of the cause of an angiographic filling defect is potentially important. We present a case report and review our experience with a flow artifact that mimicked thrombus ("pseudothrombus") in the setting of a severe proximal stenosis in the left circumflex coronary artery.

Quality of Life and Self Efficacy in Cardiac Rehabilitation Patients Over 70 Years of Age Following Acute Myocardial Infarction and Bypass Revascularization Surgery.

Does 12 weeks of cardiac rehabilitation improve quality of life and self efficacy in patients greater than 70 years of age following an acute myocardial infraction or bypass surgery? Three hundred forty four patients were divided into an Older group (70-89 years of age; n equals 122) and a younger group (50-69 years of age; n equals 222). Two hundred fifteen had bypass surgery (Surgical group) and 129 had a myocardial infarction (MI group). Quality of life emotions domain was greater for the Older group at week 12 (p equals 0.

Age and Gender Related Trends in Body Composition, Lipids, and Exercise Capacity During Cardiac Rehabilitation.

Age (40s, 50s, 60s, and 70s) and gender (125 females; 456 males) related trends for peak exercise capacity VO2peak, body composition, and lipids were reviewed for 581 cardiac rehabilitation patients. Groups were equivalent with regard to diagnoses, medications, and risk factors. Peak exercise capacity decreased with increasing age but the percentage improvement attributable to cardiac rehabilitation was similar across each age group (mean of 28.

Elderly Cardiac Rehabilitation Patients Show Greater Improvements in Ventilation at Submaximal Levels of Exercise.

The minute ventilation (VE) and carbon dioxide output (VCO&sub2;) adaptations to 12 weeks of cardiac rehabilitation were investigated in diagnosis-matched elderly patients (ELD) and younger patients (YNG). Thirty ELD (25 males, 5 females; age equals 69.2Â+/-3.