Supervised exercise training (walking) is recommended in patients with intermittent claudication, both as a means to improve symptoms (walking distance and quality of life QoL) and as a means to ...improve general cardiovascular health (including vascular function and heart rate variability HRV). Our aim was to compare two types of supervised training (moderate-pain and pain-free walking) with comparable intensity based on heart rate, in terms of walking capacity, QoL, vascular function, biomarkers, and HRV in patients with intermittent claudication.
Thirty-six adults with intermittent claudication were randomized to either moderate-pain or pain-free exercise training (36 sessions, two or three times a week) or usual care (no supervised exercise). Initial walking distance and absolute walking distance using treadmill testing, flow-mediated vasodilation and pulse wave velocity using ultrasound, N-terminal pro-B-type natriuretic peptide and fibrinogen levels, HRV, and QoL (36-Item Short Form Health Survey questionnaire) were determined at baseline and after the intervention period.
Twenty-nine patients (mean age, 64 ± 9 years; 72% male) completed the study. Both training programs similarly improved walking capacity. Initial walking distance and absolute walking distance significantly increased with either moderate-pain walking (median, 50 m to 107 m P = .005 and 85 m to 194 m P = .005, respectively) or pain-free walking (median, 53 m to 128 m P = .003 and 92 m to 163 m P = .003, respectively). QoL also similarly improved with both training modalities, whereas only moderate-pain walking was also associated with a statistically significant improvement in the vascular parameters flow-mediated vasodilation (4.4% to 8.0%; P = .002) and pulse wave velocity (6.6 m/s to 6.1 m/s; P = .013). Neither training program was associated with changes in biomarker levels and HRV.
Both moderate-pain and pain-free training modalities were safe and similarly improved walking capacity and health-related QoL. Conversely, vascular function improvements were associated with only moderate-pain walking.
Cardiovascular rehabilitation (CR) improves aerobic capacity and quality of life in patients after myocardial infarction (MI). The aim was to examine the associations between exercise capacity ...improvement and different clinically relevant cardiovascular events.
This was a registry-based study of post-MI patients, referred to CR. All patients were submitted to exercise testing before and after CR (36 sessions, 2-3 times/week, and combined exercise). Patients were divided into two groups, based on the difference in exercise capacity before and after the CR programme with the cut-off of two metabolic equivalents (METs) improvement. We assessed the correlation between the extent of exercise capacity improvement and the following cardiovascular events: major adverse cardiac events (MACE), cardiovascular-related hospitalizations, and unplanned coronary angiography. A total of 499 patients were included (mean age 56 ± 10 years, 20% women). Both groups significantly improved in terms of exercise capacity, natriuretic peptide levels, resting heart rate, and resting diastolic pressure; however, lipid status significantly improved only in patients with ≥2 METs difference in exercise capacity. A total of 13.4% patients suffered MACE (median follow-up 858 days); 21.8% were hospitalized for cardiovascular reasons (median follow-up 791 days); and 19.8% had at least one unplanned coronary angiography (median follow-up 791 days). Exercise capacity improvement of ≥2 METs was associated with lower rates of MACE, cardiovascular hospitalizations, and unplanned coronary angiography in all examined univariate and multivariate models.
This study has shown that exercise improvement of ≥2 METs is associated with a significant decrease in MACE, cardiac hospitalizations, and unplanned coronary angiography.
Background: Venous thromboembolism (VTE) is the most common unpredictable cause of in-hospital death. Despite the fact that VTE prophylaxis has been proven to be efficacious and safe it remains ...underused. The aim is to determine the use of VTE prophylaxis in patients admitted to medical wards of the Division of Internal Medicine of the University Medical Centre Ljubljana.Methods: On a pre-specified day, all patients hospitalized on the wards of the Division of Internal Medicine were assessed for VTE risk by Padua prediction score. According to the risk of VTE and contraindications for pharmacological prophylaxis the adequacy of VTE prophylaxis was determined by trained data abstractors. Doctors responsible for the patients’ treatment were not aware of the study.Results: 511 patients were enrolled (222 women and 289 men). VTE prophylaxis was not indicated in 245 patients; 17 (6.9 %) patients classified as being at low risk for VTE nevertheless received prophylaxis. A half of 266 (52.1 %) patients at high risk for VTE had a contraindication to pharmacological prophylaxis. In 133 at-risk patients without contraindications, VTE prophylaxis was prescribed correctly in 50 (37.6 %) patients, 11 (8.3 %) patients received wrong doses and 72 (52 %) at-risk patients did not receive any prophylaxis.Conclusion: On the chosen day, VTE prophylaxis was appropriately used in 81 % of hospitalized patients on medical wards of the Division of Internal Medicine of the University Medical Centre Ljubljana. Since only 37 % of the patients at high risk for VTE received recommended VTE prophylaxis, our data reinforce the rationale to implement measures to improve these results.
Background: Venous thromboembolism (VTE) is the most common unpredictable cause of in-hospital death. Despite the fact that VTE prophylaxis has been proven to be efficacious and safe it remains ...underused. The aim is to determine the use of VTE prophylaxis in patients admitted to medical wards of the Division of Internal Medicine of the University Medical Centre Ljubljana. Methods: On a pre-specified day, all patients hospitalized on the wards of the Division of Internal Medicine were assessed for VTE risk by Padua prediction score. According to the risk of VTE and contraindications for pharmacological prophylaxis the adequacy of VTE prophylaxis was determined by trained data abstractors. Doctors responsible for the patients’ treatment were not aware of the study. Results: 511 patients were enrolled (222 women and 289 men). VTE prophylaxis was not indicated in 245 patients; 17 (6.9 %) patients classified as being at low risk for VTE nevertheless received prophylaxis. A half of 266 (52.1 %) patients at high risk for VTE had a contraindication to pharmacological prophylaxis. In 133 at-risk patients without contraindications, VTE prophylaxis was prescribed correctly in 50 (37.6 %) patients, 11 (8.3 %) patients received wrong doses and 72 (52 %) at-risk patients did not receive any prophylaxis. Conclusion: On the chosen day, VTE prophylaxis was appropriately used in 81 % of hospitalized patients on medical wards of the Division of Internal Medicine of the University Medical Centre Ljubljana. Since only 37 % of the patients at high risk for VTE received recommended VTE prophylaxis, our data reinforce the rationale to implement measures to improve these results.
Izhodišče: Venski trombembolizmi so najpogostejši nepredvideni vzrok smrti v bolnišnicah. Kljub temu, da je preprečevalno zdravljenje (PZ) varno in učinkovito, se po do sedaj objavljenih podatkih ...premalokrat uporablja. Namem študije je proučiti, kako se PZ uporablja na internističnih oddelkih v Univerzitetnem kliničnem centru (UKC) v Ljubljani. Metode: Na izbrani dan smo pri vseh bolnikih, zdravljenih na Interni kliniki UKC Ljubljana, s točkovnikom Padua ocenili tveganje za nastanek VTE in potrebo po PZ. Ob upoštevanju indikacij in zadržkov za PZ smo bolnike razvrstili na tiste s pravilno in nepravilno predpisanim PZ. Podatke so zbirali neodvisni preiskovalci. Zdravniki, odgovorni za zdravljenje bolnikov, o času izvajanja raziskave niso bili obveščeni. Rezultati: Vključili smo 511 bolnikov (222 žensk in 289 moških). 245 bolnikov PZ ni potrebovalo. Pri bolnikih, ki PZ niso potrebovali, jih je imelo PZ kljub temu predpisano 17 (6,9 %). PZ bi potrebovalo 266 (52,1 %) bolnikov, vendar jih je polovica med njimi imela zadržek za PZ. Pri 133 bolnikih, ki niso imeli zadržkov, je imelo pravilno predpisano PZ 50 (37,6 %) bolnikov, 11 (8,3 %) bolnikov je imelo predpisano PZ v neustreznem odmerku. Brez PZ, od tistih, ki bi ga morali prejemati, jih je bilo 72 (52 %). Zaključek: Na izbrani dan so na internističnih oddelkih UKC Ljubljana ob upoštevanju indikacij in zadržkov za PZ pravilno obravnavali 81 % bolnikov, kar je v primerjavi z drugimi raziskavami dober rezultat. Dejstvo, da je bilo PZ pravilno predpisano pri tistih bolnikih, ki bi ga potrebovali, le pri 37 %, pa odpira možnosti za izboljšave.
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