JAHA Conference Reads
AHA’s Cardiovascular Nursing Clinical Symposium Collection
To coincide with the AHA’s Cardiovascular Nursing Clinical Symposium taking place on November 13-14 in Anaheim, CA, the JAHA Editors have selected 6 recently published articles of interest to the Clinical Nursing community.
Justin M. Bachmann, Shi Huang, Deepak K. Gupta, Loren Lipworth, Michael T. Mumma, William J. Blot, Elvis A. Akwo, Sunil Kripalani, Mary A. Whooley, Thomas J. Wang, Matthew S. Freiberg
Individual socioeconomic status has been associated with cardiac rehabilitation (CR) utilization. In this article, Bachmann et al. found that study participants living in the most deprived communities were less than half as likely to initiate CR as those in the least deprived communities. Also, CR was inversely associated with all-cause mortality.
Elena Salmoirago‐Blotcher, Peter M. Wayne, Shira Dunsiger, Julie Krol, Christopher Breault, Beth C. Bock, Wen‐Chih Wu, Gloria Y. Yeh
More than 60% of patients decline cardiac rehabilitation (CR) after myocardial infarction. Salmoriago-Blotcher and colleagues found that Tai-Chi was a promising alternative for those who decline traditional CR. Those in both a “LITE” group (2 sessions/week for 12 weeks) and those in a “PLUS” group (3 sessions/week for 12 weeks) had over 85% retention at 9-months, had no adverse events, lost weight, and had improved assessment of their quality of life.
James P. Pirruccello, Kathleen Traynor, Krishna G. Aragam
Cardiac rehabilitation (CR) remains a powerful, yet underutilized, tool in the management of post–myocardial infarction and post–percutaneous coronary intervention patients. New knowledge on the barriers to CR engagement and alternatives to traditional CR that addresses barriers at the individual level (e.g. negative sentiment toward exercise) and at the systems level (e.g. permitting CR-like activity outside of designated CR facilities) may improve access to care across socioeconomic strata. Alternative solutions will be important on the “road to increased participation” in rehabilitative services after a coronary event, with the ultimate goal of improving secondary cardiovascular prevention.
Karam I. Turk-Adawi, Neil B. Oldridge, Sergey S. Tarima, William B. Stason, Donald S. Shepard
Despite known benefits, adherence to cardiac rehabilitation (CR) is suboptimal, with dropout rates up to 50%. Turk-Adawi et al. found that patient and organizational factors were associated with increased adherence rates. Patient factors included age ≥65 years, high-risk individuals, history of bypass surgery, and diabetes mellitus. Organizational factors associated with increased adherence were relaxation training, diet classes, psychological counseling, medication counseling, and lifestyle modification recommendations.
Manuel F. Jiménez‐Navarro, Francisco Lopez‐Jimenez, Luis M. Pérez‐Belmonte, Ryan J. Lennon, Carlos Diaz‐Melean, J. P. Rodriguez‐Escudero, Kashish Goel, Daniel Crusan, Abhiram Prasad, Ray W. Squires, Randal J. Thomas
Participation in cardiac rehabilitation (CR) is an essential component of care but participation rates are lower for individuals with diabetes mellitus (DM). Jiménez-Navarro et al. found that for those with DM, CR participation was associated with a reduction in all-cause mortality, myocardial infarction, revascularization, and cardiac mortality over 8-year follow-up.
Alexis L. Beatty, Yoshimi Fukuoka, Mary A. Whooley
New strategies for promoting participation in cardiac rehabilitation are desperately needed. Initial evidence supports the feasibility and acceptability of using mobile technology for cardiac rehabilitation in patients with ischemic heart disease (IHD). Whether using mobile technology for cardiac rehabilitation can achieve its potential to improve access, increase participation, and ultimately improve outcomes in patients with IHD, remains to be seen.
7th World Congress of Pediatric Cardiology & Cardiac Surgery Collection
To coincide with the 7th World Congress of Pediatric Cardiology & Cardiac Surgery, the JAHA Editors have selected 5 related articles.
Aarti S. Dalal, Hoang H. Nguyen, Tammy Bowman, George F. Van Hare, Jennifer N. Avari Silva
Force-sensing catheters have recently been introduced to perform ablations in adult electrophysiology patients. In this article, Dalal et al. show that a force-sensing catheter can be successfully used is a pediatric population, and that less force was required than in adults. Further studies are needed to prove that these catheters provide benefit over standard catheters for pediatric ablations.
Sarah E. Woolf‐King, Alexandra Anger, Emily A. Arnold, Sandra J. Weiss, David Teitel
The extent of mental health problems in parents of children with critical congenital heart defects is unknown. In this article, Woolf-King et al. performed a systematic review of the literature to show that posttraumatic stress disorder, depression, anxiety, and severe psychological distress are common, especially following cardiac surgery. Further studies are needed to assess the implications of these psychological/psychiatric conditions of both the parents and the children.
Christine Voss, Stephanie L. Duncombe, Paige H. Dean, Astrid M. de Souza, Kevin C. Harris
The degree of physical activity in children with congenital heart disease has not been extensively studied. In this article, Voss et al. show that most children with congenital heart disease perform significant amounts of exercise, and that age and sex but not the severity of the heart disease were correlated with the amount of physical activity performed. Further studies relating physical activity to health outcomes in this population would be useful.
Kathryn Roberts, Jeffrey Cannon, David Atkinson, Alex Brown, Graeme Maguire, Bo Remenyi, Gavin Wheaton, Elizabeth Geelhoed, Jonathan R. Carapetis
The utility of screening for rheumatic heart disease using echocardiography in high risk populations is uncertain. In this article, Roberts et al. show that a strategy screening of all at-risk children every other year could be cost effective, assuming that affected children can be identified 2 years earlier and/or that rates of secondary prophylaxis can be increased. Further studies testing the screening strategy in this and other populations would be appropriate.
David J. Goldberg, Lea F. Surrey, Andrew C. Glatz, Kathryn Dodds, Michael L. O'Byrne, Henry C. Lin, Mark Fogel, Jonathan J. Rome, Elizabeth B. Rand, Pierre Russo, Jack Rychik
Although liver disease is a recognized complication following the Fontan operation, its extent is unknown. In this article, Goldberg et al. show that significant hepatic fibrosis in uniformly present following Fontan surgery, and that it correlates to time following the operation but not to abnormal liver enzymes, inferior vena cava pressure, ventricular morphology or severity of atrioventricular valve insufficiency. Further studies exploring the mechanisms underlying hepatic fibrosis and its implications for outcomes are indicated.
27th European Meeting on Hypertension and Cardiovascular Protection
To coincide with the 27th European Meeting on Hypertension and Cardiovascular Protection (ESH 2017), the JAHA Editors have selected 5 related articles.
Mark Canney, Matthew D. L. O'Connell, Donal J. Sexton, Neil O'Leary, Rose Anne Kenny, Mark A. Little, Conall M. O'Seaghdha
In this article, Canney et al. evaluates the relationship between renal function and orthostatic hypotension. They show that a) subjects with an eGFR ‹60 ml/min-1.73m2 were twice as likely to have a sustained drop in blood pressure, and b) that there was a graded association between renal function and orthostatic hypotension. These findings suggest that patients with renal insufficiency are at increased risk for injury due to falls.
Ying Yang, Fangchao Liu, Long Wang, Qian Li, Xingyu Wang, Julia C. Chen, Qiaomei Wang, Haiping Shen, Yiping Zhang, Donghai Yan, Man Zhang, Yuan He, Zuoqi Peng, Yuanyuan Wang, Jihong Xu, Jun Zhao, Ya Zhang, Hongguang Zhang, Xiaona Xin, Yan Wang, Dujia Liu, Tongjun Guo, Qiaoyun Dai, Xu Ma
In this article, Yang et al. seeks to identify the effects of second hand smoke in Chinese women. They show that women whose husbands smoked had a higher risk of hypertension, and that the risk was related to the number of cigarettes smoked. These findings suggest that smoking cessation has benefits for the family of the smoker.
Mai Tone Lønnebakken, Raffaele Izzo, Costantino Mancusi, Eva Gerdts, Maria Angela Losi, Grazia Canciello, Giuseppe Giugliano, Nicola De Luca, Bruno Trimarco, Giovanni de Simone
This article by Lønnebakken et al. seeks to identify those factors that make left ventricular hypertrophy (LVH) irreversible in patients with hypertension. They show that suboptimal blood pressure control, higher baseline LV mass index, older age, female sex, and obesity correlated with persistence of LVH. These findings suggest that early and aggressive treatment of hypertension are critical in the prevention of irreversible LVH and poorer outcomes.
Xianhui Qin, Youbao Li, Ningling Sun, Mingli He, Genfu Tang, Delu Yin, JiGuang Wang, Min Liang, Binyan Wang, Yong Huo, Xin Xu, Xiping Xu, Fan Fan Hou
This article by Qin et al. studies the relationship between successful lowering of blood pressure in patients with grade 1 hypertension and stroke risk. They show that an increased proportion of study visits with blood pressure < 140/90 was associated with a) a lower stroke risk and b) a lower all-cause mortality. These findings suggest successful treatment of hypertension decreases neurological morbidity and mortality.
Henrique C.S. Muela, Valeria A. Costa‐Hong, Mônica S. Yassuda, Natália C. Moraes, Claudia M. Memória, Michel F. Machado, Thiago A. Macedo, Edson B.S. Shu, Ayrton R. Massaro, Ricardo Nitrini, Alfredo J. Mansur, Luiz A. Bortolotto
In this article, Muela et al. seeks to identify changes in cognitive function that are related to hypertension. They show that patients with severe hypertension had impaired performance on two cognitive performance based and on neuropsychological tests. These findings suggest that hypertension leads to end-organ damage in the brain in the absence of stroke.
3rd European Stroke Organisation Conference Collection
To coincide with the 3rd European Stroke Organisation Conference, the JAHA Editors have selected 5 related articles.
Johannes Kaesmacher, Christian Maegerlein, Mirjam Kaesmacher, Claus Zimmer, Holger Poppert, Benjamin Friedrich, Tobias Boeckh‐Behrens, Justus F. Kleine
In this article, Kaesmacher et al. evaluate the frequency of thrombus migration in patients with left middle cerebral artery stroke prior to interventional endovascular therapy. They show a) clot migration is common; b) that recombinant tissue plasminogen activator (rTPA) does not increase the frequency of clot migration; and c) that patients with clot migration have lower rates of complete reperfusion with intervention and worse outcomes. These findings suggest that thrombus migration on serial imaging studies is a negative prognostic factor in this subset of strokes.
Konrad Koch, Dirk Berressem, Jan Konietzka, Anna Thinnes, Gunter P. Eckert, Jochen Klein
Koch et al evaluate the effect of stroke (caused by middle cerebral artery occlusion for 90 minutes followed by reperfusion) in mice on normal and fat-rich diets. They show that a) mice on fat-rich diets have increased β‐hydroxybutyrate (ketone bodies) and less glucose in the liver, plasma, and brain during ischemia, and reversal towards baseline during reperfusion; and b) that the β -adrenergic blocker propanolol prevents these changes. These findings suggest that diet and cardiac medications may influence substrate availability to the brain during stroke.
Lu Ban, Nikola Sprigg, Alyshah Abdul Sultan, Catherine Nelson‐Piercy, Philip M. Bath, Jonas F. Ludvigsson, Olof Stephansson, Laila J. Tata
In this article, Ban and colleagues evaluate the incidence of a first stroke during pregnancy and the period around childbirth. They show that a) strokes are rare at baseline; b) the risk of stroke (both ischemic and hemorrhagic) is decreased throughout pregnancy (0.5-0.8 fold); and c) the risk of stroke is significantly increased during the peripartum (2 days before to 1 day after birth; 9-fold) and early postpartum period (first 6 weeks after birth; 3-fold). These findings suggest that the risk of stroke is markedly increased during the period around childbirth but not during pregnancy.
Sofie Schmid, Pavlos Tsantilas, Christoph Knappich, Michael Kallmayer, Thomas König, Thorben Breitkreuz, Alexander Zimmermann, Andreas Kuehnl, Hans‐Henning Eckstein
In this article, Schmid and colleagues evaluate the effect of age and sex on stroke and death in a large German cohort treated by carotid endarterectomy. They show that a) stroke (1.4%) and death (0.6%) are uncommon; b) older age is associated with a significantly greater risk of death (1.7 fold over 10 years), but with only a marginally increased risk of stroke (1.05 fold over 10 years); and c) that sex is not associated with a difference in death and/or stroke. These findings suggest that carotid endarterectomy is equally safe for men and women.
Ralph L. Sacco, Hannah Gardener, Kefeng Wang, Chuanhui Dong, Maria A. Ciliberti‐Vargas, Carolina M. Gutierrez, Negar Asdaghi, W. Scott Burgin, Olveen Carrasquillo, Enid J. Garcia‐Rivera, Ulises Nobo, Sofia Oluwole, David Z. Rose, Michael F. Waters, Juan Carlos Zevallos, Mary Robichaux, Salina P. Waddy, Jose G. Romano, Tatjana Rundek, the FL‐PR CReSD Investigators and Collaborators
The article by Sacco et al. evaluates stroke care by racial group in Florida and Puerto Rico. They show that a) the quality of stroke care was similar in non-Hispanic blacks, non-Hispanic whites, and Hispanics in Florida, but lower in Hispanics in Puerto Rico; and b) stroke care markedly improved in all locations between 2010 and 2014, although the disparities in Puerto Rico remained. These findings suggest that in Florida and Puerto Rico, regional disparities in care outweigh those based on racial-ethnic groups.