Rationale and Design of a Randomized Trial on the Effectiveness of Aerobic Interval Training in Patients With Coronary Artery Disease: The SAINTEX-CAD Study.

Rationale and design of a randomized trial on the effectiveness of aerobic interval training in patients with coronary artery disease: The SAINTEX-CAD study.

Int J Cardiol. 2013 May 24;
Conraads VM, Van Craenenbroeck EM, Pattyn N, Cornelissen VA, Beckers PJ, Coeckelberghs E, De Maeyer C, Denollet J, Frederix G, Goetschalckx K, Hoymans VY, Possemiers N, Schepers D, Shivalkar B, Vanhees L

BACKGROUND: Exercise-based cardiac rehabilitation is considered an important adjunct treatment and secondary prevention measure in patients with coronary artery disease (CAD). However, the issues of training modality and exercise intensity for CAD patients remain controversial. OBJECTIVE: Main aim of the present study is to test the hypothesis that aerobic interval training (AIT) yields a larger gain in peak aerobic capacity (peakVO2) compared to a similar training programme of moderate continuous training (MCT) in CAD patients. STUDY DESIGN: In this multicentre study stable CAD patients with left ventricular ejection fraction>40% will be randomized after recent myocardial infarction or revascularization (PCI or CABG) to a supervised 12-week programme of three weekly sessions of either AIT (85-90% of peak oxygen uptake [peakVO2], 90-95% of peak heart rate) or MCT (60-70% of peakVO2, 65-75% of peak heart rate). The primary endpoint of the study is the change of peakVO2 after 12weeks training. Secondary endpoints include safety, changes in peripheral endothelial vascular function, the evolution of traditional cardiovascular risk factors, quality of life and the number and function of circulating endothelial progenitor cells as well as endothelial microparticles. Possible differences in terms of long-term adherence to prescribed exercise regimens will be assessed by regular physical activity questionnaires, accelerometry and reassessment of peakVO2 12months after randomization. A total number of 200 patients will be randomized in a 1:1 manner (significance level of 0.05 and statistical power of 0.90). Enrolment started December 2010; last enrolment is expected for February 2013. HubMed – rehab


Thirty-day prevalence of delirium among very old people: A population-based study of very old people living at home and in institutions.

Arch Gerontol Geriatr. 2013 May 24;
Mathillas J, Olofsson B, Lövheim H, Gustafson Y

Delirium has mainly been studied in various patient samples and in people living in institutions. The present study investigates the 30-day prevalence of delirium in a population-based sample of very old people in northern Sweden and Finland. Seven hundred and eight persons aged 85 years and older from the GErontological Regional DAtabase (GERDA) were assessed. Information was also collected from relatives, carers and medical records. Assessments performed were among others the Organic Brain Syndrome (OBS) scale, the Mini Mental State Examination (MMSE), and the Geriatric Depression Scale-15 (GDS-15). Delirium, depression and dementia diagnoses were based on the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV) criteria. The prevalence of delirium was 17% among 85 year-olds, 21% among 90 year-olds and 39% among participants aged 95 years and older (p<0.001). Delirium prevalence among individuals without dementia was lower than among those with dementia (5% vs. 52%, p<0.001). Factors independently associated with delirium superimposed on dementia in a multivariate logistic regression model were depression (Odds Ratio (OR)=2.0, 95% Confidence Interval (CI)=1.2-3.3), heart failure (OR=2.1, 95% CI=1.2-3.7), institutional living (OR 4.4, 95% CI=2.4-8.2) and prescribed antipsychotics (OR=3.0, 95% CI=1.5-6.0). Delirium is highly prevalent among very old people with dementia. Depression, heart failure, institutional living and prescribed antipsychotic medication seem to be associated with delirium. HubMed – rehab


Frequency of referral to and attendance at a pulmonary rehabilitation program amongst patients admitted to a tertiary hospital with chronic obstructive pulmonary disease.

Respirology. 2013 May 27;
Johnston K, Young M, Grimmer K, Antic R, Frith P

BACKGROUND AND OBJECTIVE: Pulmonary rehabilitation is recommended in the management of people with chronic obstructive pulmonary disease (COPD) but implementation appears to be low. The aim of this study was to determine the frequency of referral to, and attendance at, pulmonary rehabilitation programs in a sample of patients with COPD. METHODS: A cross-sectional study of patients admitted to a tertiary hospital in Adelaide, South Australia, with a primary diagnosis of COPD between March and November 2011 was conducted. Data were collected from medical records and patient interview. RESULTS: From 235 admissions with preliminary coding as COPD, 88 patients had COPD as the primary reason for admission and were potentially eligible for rehabilitation. While 57% had been referred to rehabilitation during their disease course, only 18% had attended and completed at least half the program. Seven patients had attended in the previous two years. Mean percentage predicted forced expiratory volume in 1 second was 42% at the time of referral. During the index admission, discussion of rehabilitation resulting in a referral occurred in 14 cases (16%). No demographic or disease characteristics were associated with referral/no referral; but being reviewed by a COPD nurse coordinator during admission increased the likelihood of referral (OR=18.7, 95% CI 3.8 – 91.4). CONCLUSIONS: Pulmonary rehabilitation had been implemented in a small proportion of patients admitted to hospital with an exacerbation of COPD due to gaps in both referral to, and subsequent attendance at a program. Strategies to improve referral to, and participation in pulmonary rehabilitation are required. HubMed – rehab