Lecture notes
Unit 4 Summary for Cardiovascular
- Module
- Cardiovascular (HH5607)
- Institution
- Brunel University (BU)
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1. What is the definition of cardiac rehabilitation? What is meant by the “sum” of activities? thecoordinated sum of activities * required to influence favourably the underlying cause of CV
disease, as well as to provide the best possible physical, mental and social conditions so that
patients may, by their own efforts, preserve or resume optimal functioning in their community
and through improved health behaviour, slow or reverse progression of disease.
2. PCI reduces mortality, reduces hospitalisations, increases exercise capacity and improves
symptoms in stable angina compared to medication optimisation – TRUE or FALSE (explain)
True but exercise is far more superior. Works better in the case of STEMIs.
3. The meta-analysis by van Halewijn et al. (2017) supports comprehensive cardiac rehabilitation
that includes intensive risk factor management. A minimum of how many risk factors need to be
managed in order to see that cardiac rehabilitation remains very beneficial in terms of improved
survival? 6
4. According to the COURAGE trial which four risk factors were most strongly associated with
long-term survival? Not smoking, PA, DIET, and systolic BP
5. Cardiac rehabilitation has the potential to widen health inequalities – TRUE
A RCT: Percutaneous coronary angioplasty compared with Exercise Training in Patients with
Stable Coronary Artery Disease
Better chance of survival with exercise, called glue in CR
The ORBITA trial: looked at value of angioplasty and stenting in people with stable angina and
similar finding that better exercise time and symptom relief. Exercise training is far more
superior. Use of stenting in STEMI is still of great value.
Key Evidence- Cochrane reviews
Post MI/ Revasc:
Absolute risk reduction in CV mortality from 7.6% to 10.4%
Reduction in acute hospital admissions from 26.1% to 30.7%
No effect of recurrent MI and repeat revascularization
Heart failure
25% relative risk reduction in overall hospital admissions and 39% reduce in acute heart
failure related epiosides
Clinically relevant (and highly statistically significant) change in Minnesota Living with
Heart Failure questionnaire point score of 5.8
SR and Meta-analysis: Is Exercise based cardiac rehab effective
SR and meta-analysis: lessons from contemporary trials of CV prevention and rehab. Look at
dose that studies are giving if they say benefit is diminished. Have to give doses associated with
benefit.
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