Personalized Rehab Benefits Older Patients With Heart Failure
Although research indicates that older adults hospitalized with acute decompensated heart failure (HF) have high rates of poor quality of life, delayed recovery, physical frailty, and frequent rehospitalization, well-established interventions to address physical frailty in this population are lacking. Researchers conducted a study to evaluate a transitional, tailored, progressive rehabilitation intervention including four physical function domains (balance, endurance, mobility, strength) that is initiated during, or early after, hospitalization and continued for 36 outpatient sessions among patients hospitalized with HF who had markedly impaired physical function and a frail or prefrail rate of 97%. After adjusting for baseline Short Physical Performance Battery score (range of 0-12, with lower scores indicating more severe physical dysfunction) and other baseline characteristics, the least-squares mean score on the Short Physical Performance Battery at 3 months was 8.3 among patients assigned to the intervention, compared with 6.9 in a standard care group. All-cause, 6-month rehospitalization rates were 1.18 and 1.28 in the intervention and standard care groups, respectively, while all-cause mortality rates were 0.13 and 0.10, respectively.
Distress Doubles Cardiac Events in Young MI Survivors
With little known regarding psychological distress and residual risk of future cardiovascular events in young and middle-aged patients with a recent myocardial infarction (MI), researchers divided patients aged 18-61 with an MI in the previous 8 months into tertiles of mild, moderate, or high distress based on composite psychological distress scores. Patients with high distress were more likely to be Black, female, and socioeconomically disadvantaged (low education and income, unemployed) and to have diabetes, hypertension, or a smoking history. Major adverse cardiovascular events (MACE) were experienced by 37% of those in the high distress group, compared with 17% in the mild distress group, equating to a 2.7-fold increased risk of MACE during 5 years of follow-up for the high distress group. The increased risk was similar (2.5-fold) after adjusting for age, sex, race, and education, but it was attenuated after further adjustment for BMI, smoking, hypertension, diabetes, dyslipidemia, and medications (hazard ratio [HR], 1.9) and was no longer significant after even further adjustment for interleukin-6 and monocyte chemoattractant protein-1 (HR, 1.5).
Findings Question Omega-3 Fatty Acids for High-Risk
Patients Prior research provides unclear results on the benefits of omega-3 fatty acids for the prevention of cardiovascular outcomes in patients with high cardiovascular risk. To determine the association of plasma levels of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) with cardiovascular outcomes, researchers randomized patients at high cardiovascular risk with elevated triglyceride levels and low HDL cholesterol levels to 4 g daily of omega-3 carboxylic acid (CA) or corn oil placebo. The median plasma EPA level for the omega-3 group was 89 µg/mL, with the top tertile achieving levels of 151 µg/mL (a 443% increase). The median level of DHA was 91 µg/mL, rising to 118 g/mL (a 68% increase) in the top tertile. No differences were observed in the composite endpoint of cardiovascular death, nonfatal myocardial infarction, nonfatal stroke, coronary revascularization, or unstable angina requiring hospitalization. Event rates were 11.4% and 11.0% for those in the top tertile of achieved DHA levels and the corn oil group, respectively. “These findings suggest that supplementation of omega-3 fatty acids in high-risk cardiovascular patients is neutral even at the highest achieved levels,” the presenting author said. “And, in the context of increased risk of atrial fibrillation in omega-3 trials, they cast uncertainty over whether there is net benefit or harm with any omega-3 preparation.”
Renal Denervation Reduces BP in Resistant Hypertension
Previous studies suggest that endovascular renal denervation reduces blood pressure (BP) in patients with mild-to-moderate hypertension. However, its efficacy in patients with resistant hypertension remains unknown. To assess the efficacy and safety of endovascular ultrasound renal denervation in patients aged 18-75 with office BP of 140/90 mm Hg despite three or more antihypertensives, including a diuretic, investigators first switched patients to a once daily combination of a calcium channel blocker, an angiotensin receptor blocker, and a thiazide diuretic. Participants with daytime ambulatory BP of at least 135/85 mm Hg after 4 weeks were randomized to denervation or a sham procedure. Daytime ambulatory systolic BP was reduced by 8 mm Hg with renal denervation, compared with a reduction of 3 mm Hg with the sham procedure. The median between-group difference was -5.8 mm Hg among patients with complete ambulatory BP data. No differences were observed between the groups in safety outcomes.
Low- & High-Dose Aspirin Achieve Similar Results in CHD
United States guidelines suggest any aspirin dose between 81 mg and 325 mg daily for patients with coronary heart disease, while European guidelines that recommend 81 mg daily are mainly based on observational data and expert opinion. To help determine the best aspirin dose for this patient population, investigators randomly assigned patients with established heart disease to 81 mg or 325 mg of aspirin daily. After a mean follow-up of 26 months, a composite of all-cause death, myocardial infarction, or stroke occurred in 7.28% of those assigned to 81 mg and 7.51% of those assigned to 325 mg. Hospitalization for major bleeding with an associated blood transfusion occurred in 0.63% of the 81 mg group and 0.60% of the 325 mg group. Dose switching occurred in 41.6% of those assigned to 325 mg, compared with 7.1% of those assigned to 81 mg, while treatment discontinuation occurred in 11.1% and 7.0%, respectively.
