The 2013 Canadian Cardiovascular Society Heart Failure Management Guidelines Update: Focus on Rehabilitation and Exercise and Surgical Coronary Revascularization

Moe, Gordon W.; O’Meara, Eileen; Howlett, Jonathan G.; Fremes, Stephen E.; Al‐Hesayen, Abdul; Heckman, George A.; Ducharme, Anique; Estrella-Holder, E.; Grzeslo, Adam; Harkness, Karen; Lepage, Serge; McDonald, Michael; McKelvie, Robert S.; Nigam, Anil; Rao, Vivek; Swiggum, Elizabeth; Virani, Sean; Le, Vy Van; Zieroth, Shelley; Arnold, J. Malcolm O.; Ashton, Tom; D’Astous, Michel; Dorian, Paul; Giannetti, Nadia; Haddad, Haissam; Isaac, Debra; Kouz, Simon; Leblanc, Marie-Hélène; Liu, Peter; Ross, Heather J.; Sussex, Bruce; White, Michel

doi:10.1016/j.cjca.2013.10.010

Cited by 51 publications

(29 citation statements)

References 97 publications

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“…While the effects on overall quality of life are variable and the impact on hospitalization and mortality rates is unknown, a similar approach is reasonable in patients with HFpEF (76). Suggestions for patient selection, exercise prescription, and self-care counseling related to exercise training have recently been reviewed (77).…”

Section: Non-pharmacological Treatment In Elderly Hf Patientsmentioning

confidence: 99%

Heart Failure in Older Adults

Butrous

Hummel

2016

Canadian Journal of Cardiology

120

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Heart failure (HF) is a leading cause of morbidity, hospitalization, and mortality in older adults, and a growing public health problem placing a huge financial burden on the health care system. Many challenges exist in the assessment and management of HF in geriatric patients, who often have co-existing multi-morbid illness, polypharmacy, cognitive impairment, and frailty. These complex ‘geriatric domains’ greatly affect physical and functional status as well as long-term clinical outcomes. Geriatric patients have been under-represented in major HF clinical trials. Nonetheless, available data suggest that guideline-based medical and device therapies improve morbidity and mortality. Non-pharmacological strategies, such as exercise training and dietary interventions, are an active area of research. Targeted geriatric evaluation including functional and cognitive assessment can improve risk stratification and guide management in older HF patients. Clinical trials that enroll multi-morbid older HF patients and evaluate functional status and quality of life in addition to mortality and cardiovascular morbidity should be encouraged to guide management of this age group.

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Section: Non-pharmacological Treatment In Elderly Hf Patientsmentioning

confidence: 99%

Heart Failure in Older Adults

Butrous

Hummel

2016

Canadian Journal of Cardiology

120

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“…Aerobic exercise training shows a cardiovascular, skeletal muscle, endurance, pulmonary function, inflammatory profile, depression and stress symptoms, and quality of life improvement, as well as improving significant outcomes such as mortality [4-6] . Recent systematic reviews have shown that exercise training programs are capable of reducing mortality, reducing hospitalizations, and improving the quality of life of patients with coronary artery disease, chronic heart failure (CHF) and patients who have undergone CABG [7-10] .…”

Section: Introductionmentioning

confidence: 99%

Effects of High-Intensity Inspiratory Muscle Training Associated with Aerobic Exercise in Patients Undergoing CABG: Randomized Clinical Trial

Miozzo¹,

Stein²,

Marcolino³

et al. 2018

Braz J Cardiovasc Surg

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ObjectiveEvaluate the interaction between high-intensity inspiratory muscle training (IMT) and aerobic exercise on physical capacity, respiratory muscle strength, peripheral muscle strength, and quality of life of patients who underwent coronary artery bypass grafting (CABG).MethodsTwenty-four patients underwent CABG were randomized into two groups. During 36 sessions, one group received IMT associated with aerobic exercise and the other group received only aerobic exercise. Primary outcome was the distance in the six-minute walk distance (6MWD) test. Secondary outcomes included respiratory muscle strength, peripheral muscle strength, and quality of life. Measures were taken at the baseline, at the 12th session, the 24th session, and 36th session.ResultsBaseline characteristics were similar between the groups. There was no statistically significant difference between the two groups in any outcome [6MWD - P=0.935; peak oxygen consumption (PeakVO2) - P=0.853; maximal inspiratory pressure (MIP) - P=0.243; maximal expiratory pressure (MEP) - P=0.268; sitting-rising test (SRT) - P=0.212], but there was interaction in MIP (P=0.000) and all outcomes improved in the two groups (6MWD - P=0.000; PeakVO2 - P=0.000; MIP - P=0.000; MEP - P=0.000; SRT - P=0.000).ConclusionThere was an improvement of all outcomes in both groups, but IMT was not able to provide additional benefits. The use of this combination should be used with caution to not generate higher costs in the rehabilitation process of these patients.

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“…[58][59][60] It has been shown that changes in LV ejection fraction after revascularization are linearly correlated with the number of viable segments and baseline amount of scar, resulting in a general consensus about patient-based criteria for prediction of global LV improvement after revascularization. [60][61][62] Although no LGE or less than 25% transmurality is the best predictor of recovery, segments with less than 50% of transmural LGE extent are generally considered viable. 63 The latter threshold has also been implemented in current guidelines as an established predictor of significant LV function improvement after coronary revascularization ( Table 5).…”

Section: Prognostic Value Of Late Gadolinium Enhancement Imaging Aftementioning

confidence: 99%

“…63 The latter threshold has also been implemented in current guidelines as an established predictor of significant LV function improvement after coronary revascularization ( Table 5). 62 Although it is not routinely part of myocardial viability assessment in cardiac MR, 62,64 several studies have shown the prognostic value of MR stress perfusion in the assessment of myocardial ischemia and an improved accuracy of LGE imaging in viability imaging. 51,[65][66][67] Microvascular obstruction MVO or the no-reflow phenomenon is defined as an area of nonviable tissue within the infarct core mainly related to microvascular injury with endothelial swelling/blebs.…”

Section: Prognostic Value Of Late Gadolinium Enhancement Imaging Aftementioning

confidence: 99%