Abstract Background Bariatric surgery leads to profound weight loss, but postoperative complications and psychosocial issues may impact long-term quality of life. The primary aim of this project was ...to examine whether such patients have better quality of life and self-reported functional status compared with obese adults who do not have bariatric surgery. Methods This population-based study of patients evaluated for Roux-en-Y gastric bypass surgery involved a survey consisting of baseline and follow-up single-item overall quality-of-life items (Linear Analogue Self-Assessment Questionnaire; LASA), follow-up quality of life (Short-Form-12), and activity (Goldman's Specific Activity Scale). A total of 268 and 273 surveys were mailed, with 148 (55.2%) operative and 88 (32.2%) nonoperative survey responders assessed, respectively. Linear regression was used, adjusting for changes in co-morbidity and functional status, to assess the differences in quality of life and activity level. Individual predictors of higher or better quality-of-life scores also were assessed. Results There were no major differences in baseline characteristics between survey responders and nonresponders. Mean follow-up was 4.0 and 3.8 years in the operative and nonoperative groups, respectively. The change in overall LASA from baseline to follow-up between groups was 3.1 ± 0.4 ( P <.001). The adjusted Short-Form-12 score was 14.4 points higher in operative patients ( P <.001) at follow-up. Operative patients had symptomatic improvement as measured by Specific Activity Scale status (odds ratio 7.5, P <.001) and self-reported exercise tolerance (odds ratio 2.61, P = .01) at follow-up compared with nonoperative patients. Predictors of a high follow-up LASA ( P <.05) included initial treatment for depression, percent of weight lost, and absence of dyslipidemia and cardiovascular disease. Follow-up Short-Form-12 predictors included percent of weight loss, absence of baseline diabetes, baseline depression treatment, and follow-up cardiovascular disease. Conclusions Profound weight loss after bariatric surgery, seeking treatment for depression, and absence of medical co-morbidities appears to predict better quality of life and self-reported functional status.
Throughout the COVID-19 pandemic, thousands of temporary ICUs have been established worldwide. The outcomes and management of mechanically ventilated patients in these areas remain unknown.
To ...investigate mortality and management of mechanically ventilated patients in temporary ICUs.
Observational cohort study in a single-institution academic center. We included all adult patients with severe COVID-19 hospitalized in temporary and conventional ICUs for invasive mechanical ventilation due to acute respiratory distress syndrome from March 23, 2020, to April 5, 2021.
To determine if management in temporary ICUs increased 30-day in-hospital mortality compared with conventional ICUs. Ventilator-free days, ICU-free days (both at 28 d), hospital length of stay, and ICU readmission were also assessed.
We included 776 patients (326 conventional and 450 temporary ICUs). Thirty-day in-hospital unadjusted mortality (28.8% conventional vs 36.0% temporary, log-rank test
= 0.023) was higher in temporary ICUs. After controlling for potential confounders, hospitalization in temporary ICUs was an independent risk factor associated with mortality (hazard ratio, 1.4; CI, 1.06-1.83;
= 0.016).There were no differences in ICU-free days at 28 days (6; IQR, 0-16 vs 2; IQR, 0-15;
= 0.5) or ventilator-free days at 28 days (8; IQR, 0-16 vs 5; IQR, 0-15;
= 0.6). We observed higher reintubation (18% vs 12%;
= 0.029) and readmission (5% vs 1.6%;
= 0.004) rates in conventional ICUs despite higher use of postextubation noninvasive mechanical ventilation (13% vs 8%;
= 0.025). Use of lung-protective ventilation (87% vs 85%;
= 0.5), prone positioning (76% vs 79%;
= 0.4), neuromuscular blockade (96% vs 98%;
= 0.4), and COVID-19 pharmacologic treatment was similar.
We observed a higher 30-day in-hospital mortality in temporary ICUs. Although both areas had high adherence to evidence-based management, hospitalization in temporary ICUs was an independent risk factor associated with mortality.
Several studies have suggested that epicardial adipose tissue (EAT) is associated with coronary artery disease (CAD). However, the role of EAT as a potential risk factor for, and predictor of, ...long-term cardiovascular outcomes in patients with CAD requires additional investigation. We investigated the relation among EAT, cardiovascular events, and measures of adiposity in patients with CAD. The study was a prospective cohort study of 194 consecutive patients with CAD who entered a phase II cardiac rehabilitation program at the Mayo Clinic. EAT was measured using echocardiography. The primary outcome was the long-term recurrence of major adverse cardiovascular events (MACE). The outcomes were assessed using the Mayo Clinic electronic medical records. The mean age was 59.4 ± 10.8 years, the body mass index was 28.7 ± 4.6 kg/m2 , 80% were men, and 21% of the patients underwent coronary artery bypass grafting. The mean follow-up period was 3.6 ± 1.3 years, and 52 MACE occurred. EAT was not a predictor of MACE (hazard ratio 1.32, 95% confidence interval 0.75 to 2.31; p = 0.33) when used as a continuous variable and correlated poorly with the measures of adiposity. However, a nonsignificant trend was seen for a greater incidence of cardiovascular events when EAT was stratified by tertile (hazard ratio for third tertile 1.77, 95% confidence interval 0.84 to 3.32; p = 0.11), after statistical adjustments for age, gender, body mass index, and other covariates. In conclusion, the results of the present longitudinal study suggest that EAT, as measured using echocardiography, does not strongly predict for MACE and is poorly associated with measures of obesity in patients with CAD.
Obesity and Hypertrophic Cardiomyopathy Ommen, Steve R., MD; Lopez-Jimenez, Francisco, MD, MSc
Journal of the American College of Cardiology,
07/2013, Letnik:
62, Številka:
5
Journal Article
Recenzirano
Odprti dostop
Is it a more severe expression of HCM that leads to obesity, or is it the general trend of increasing body weight in Western society that complicates HCM? Because this was an observational study, we ...cannot tell the direction of the association. ...treating patients with HCM and obesity will necessarily involve treating both aspects.
Background The prevalence of coronary artery disease (CAD) in Latin America is increasing and contributes importantly to the global burden of cardiovascular diseases. Advanced resources for the ...diagnosis and treatment of CAD are available in most of the region. However, preventive approaches such as cardiovascular rehabilitation programs (CVRP) may not be widely implemented. Methods We carried out a telephone-based survey to hospitals sampled in a random and population-weighted fashion from a list of 202 centers with cardiac catheterization laboratories in Mexico, Central and South America, and the Caribbean. We collected information of availability of cardiac procedures and imaging techniques and also extensive data about the presence, characteristics, and quality measures of CVRP. Results A total of 98 centers were contacted, and a complete survey was provided by 59 centers (60%) from 13 countries. Cardiovascular rehabilitation programs were available in only 56% of centers. There were no differences between centers with and without CVRP regarding type of hospital, availability of cardiac surgery, and annual volume of patients with myocardial infarction. Among centers with CVRP, 70% offered all phases of CVRP. The lack of CVRP was attributed to lack of qualified personnel in 41% of centers, financial constraints in 33%, and lack of physical space in 13%. All centers without CVRP performed cardiac surgery and percutaneous interventions. Conclusions Despite the presence of state-of-the-art technology for the diagnosis and treatment of CAD, availability of CVRP, a less expensive yet effective tool for the treatment of CAD, appears to be limited in Latin America and the Caribbean.
Introduction Despite the association of central obesity with adverse outcomes, most patients with cardiovascular disease (CVD) are unable to successfully lose weight. We undertook this analysis to ...evaluate the effect of motivational factors, and clinical factors, including physician diagnosis of overweight, on weight loss in patients with CVD and central obesity in the United States. Methods and Results We used data from the National Health and Nutrition Examination Survey 1999 to 2004. Waist circumference ≥102 cm in men and ≥88 cm in women were used to classify central obesity. We examined demographic, motivational and clinical determinants of attempted and successful weight loss using multivariable logistic regression. Successful weight loss was defined as ≥5% weight loss in the preceding year. There were 907 respondents with CVD and central obesity of which 78% were aware of their overweight status and 80% were desirous to weigh less. Despite this awareness and desire, only 49% of centrally obese adults had attempted weight loss in the last year. Only 62% (n = 584) reported that they had been informed that they were overweight by a physician. On multivariable analysis, physician diagnosis of overweight was a significant predictor of weight loss attempts (OR 2.42, 95% CI 1.44-4.09, P = .006) and successful weight loss (OR 2.70, 95% CI 1.40-5.19, P = .001). Conclusion In a nationally representative sample of adults with CVD and central obesity, physician diagnosis of overweight status emerged as a significant predictor of attempted and successful weight loss.
Abstract Cardiac rehabilitation (CR) improves exercise capacity, but not all CR participants achieve such improvements. Our primary aim was to develop a tool to identify those with suboptimal ...improvement in exercise capacity (EC) after CR. We retrospectively analyzed 541 patients enrolled in a phase-II cardiac rehabilitation program following a cardiac event or intervention from 2003 to 2014. EC was assessed with the 6-minute walk test (6MWT). We developed a multivariable linear regression model and corresponding nomogram to predict EC after CR. The predictors included in the final model were age, sex, baseline EC, primary referral diagnosis, body mass index, systolic blood pressure (SBP) at rest, triglycerides, low density lipoprotein cholesterol (LDL-C), lipid-lowering medication use, and an interaction term of LDL-C with lipid-lowering therapy. The prediction model was internally validated using bootstrap methods and a nomogram was created for ease of use. In conclusion, this tool helps to identify those patients with suboptimal improvement in EC who could be targeted for individualized interventions to increase their performance.
To investigate the association of pet ownership, and specifically dog ownership, with cardiovascular diseases (CVD) risk factors and cardiovascular health (CVH) in the Kardiovize Brno 2030 study, a ...randomly selected prospective cohort in Central Europe.
We included 1769 subjects (aged from 25 to 64 years; 44.3% males) with no history of CVD who were recruited from January 1, 2013, to December 19, 2014. We compared sociodemographic characteristics, CVD risk factors, CVH metrics (ie, body mass index, healthy diet, physical activity level, smoking status, blood pressure, fasting glucose, and total cholesterol), and score between pet owners and non-pet owners or dog owners and several other subgroups.
Approximately 42% of subjects owned any type of pet: 24.3% owned a dog and 17.9% owned another animal. Pet owners, and specifically dog owners, were more likely to report physical activity, diet, and blood glucose at ideal level, and smoking at poor level, which resulted in higher CVH score than non-pet owners (median, 10; interquartile range = 3 vs median, 9; interquartile range = 3; P=0.006). Compared with owners of other pets, dog owners were more likely to report physical activity and diet at ideal level. The comparison of dog owners with non-dog owners yielded similar results. After adjustment for covariates, dog owners exhibited higher CVH scores than non-pet owners (β=0.342; SE=0.122; P=0.005), other pet-owners (β=0.309; SE=0.151; P=0.041), and non-dog owners (β=0.341; SE=0.117; P=0.004).
Except for smoking, dog owners were more likely to achieve recommended level of behavioral CVH metrics (physical activity and diet) than non-dog owners, which translated into better CVH.
las enfermedades cardiovasculares representan la primera causa de morbimortalidad en muchos países del mundo, entre los que se incluye Colombia. Es así como la rehabilitación cardiovascular se ...convierte en una estrategia de prevención secundaria con intervención integral y costo-efectiva para este tipo de pacientes.
evaluar la situación actual de los programas de Rehabilitación Cardiovascular en Colombia.
estudio descriptivo, realizado por medio de un cuestionario escrito, aplicado al coordinador y/o responsable de cada programa de Rehabilitación Cardiovascular del país.
44 de 49 centros contactados respondieron el cuestionario. 88,6% de los programas pertenece a la red privada y 6,8% a la pública; 75% funciona dentro de un hospital o clínica y 25% son extra hospitalarios. La enfermedad coronaria es la principal patología que genera la remisión de los pacientes a los centros de rehabilitación cardiovascular. El recurso humano es variable en cuanto a su conformación, permanencia y actividades al interior del programa. Todos los centros realizan la fase II, seguida por las fases III (84,1%), I (70,5%) y IV (45,5%). 58% de los programas siempre incluye pruebas diagnósticas de factores de riesgo convencionales (colesterol total y fracciones, triglicéridos y glicemia); 97,7% de los programas refiere evaluar al paciente de manera integral con la inclusión de aspectos de actividad física y nutrición; sin embargo, se evidencia menor porcentaje de implementación del manejo del tabaquismo (45,5%), así como de programas de salud cardiovascular en la mujer (15,95%), prevención cardiovascular para la comunidad (18,2%), pruebas para detección de depresión (25%), apnea del sueño (0%) y caminata de seis minutos (65,9%). La principal barrera detectada en la atención de pacientes corresponde a la falta de remisión por parte del médico tratante (65,9%).
el desarrollo de los programas de Rehabilitación Cardiovascular en el país debe evaluarse de acuerdo con las cifras de morbimortalidad cardiovascular, la estratificación del riesgo de los pacientes, el acceso al servicio y los resultados más relevantes de este estudio, por lo cual se hace necesario trabajar en la definición de las líneas de base de los requerimientos de los programas que favorezcan el trabajo y la aproximación interdisciplinaria e integral así como el cumplimiento de los objetivos, dando prioridad a la seguridad del paciente.
cardiovascular diseases are the leading cause of morbidity and mortality in many countries around the world, including Colombia. Thus, cardiovascular rehabilitation becomes a secondary prevention strategy with integral and cost-effective intervention for these patients.
to assess the current status of cardiac rehabilitation programs in Colombia.
a descriptive study, carried out through a written questionnaire, applied to the coordinator and/or responsible for each cardiac rehabilitation program in the country.
44 of 49 centers contacted answered the questionnaire. 88.6% of the programs belonging to the private network and 6.8% to the public; 75% work within a hospital or clinic and 25% are outpatient. Coronary heart disease is the main pathology that generates the referral of patients to cardiovascular rehabilitation centers. Human resources are variable in their shape, stay and activities within the program. All centers perform phase II, followed by stages III (84.1%), I (70.5%) and IV (45.5%). 58% of the programs always include diagnostic tests for conventional risk factors (total cholesterol and fractions, triglycerides and glucose), 97.7% of the programs referred to assess the patient in a holistic manner including aspects of nutrition and physical activity; however, a lower percentage of implementation of the management of smoking (45.5%), of cardiovascular health programs in women (15.95%), cardiovascular prevention for the community (18.2%), testing detection of depression (25%), sleep apnea (0%) and six minute walk (65.9%) was noticed. The main barrier identified in the care of patients corresponds to the lack of referral by the treating physician (65.9%).
the development of cardiac rehabilitation programs in the country should be assessed according to the cardiovascular morbidity and mortality rates, risk stratification of patients, access to the service and the most important results of this study, thereby making necessary to work on defining the baselines of the requirements of the programs that encourage work and interdisciplinary and integral approach as well as the fulfillment of the objectives, giving priority to patient safety.
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