Aim. Exercise-based cardiac rehabilitation (exCR) reduces morbidity and mortality after acute coronary syndrome (ACS). Little is known about physical activity (PA) levels at exCR program completion and associated demographic, medical, and psychosocial factors. Methods. Cross-sectional data from the ongoing Keep-Up-Going study were used, including 100 participants with recent ACS and ≥80% attendance to 3 months supervised exCR program. Physical activity was assessed by an accelerometer and self-reported psychosocial characteristics were collected at the end of the exCR. Associations between achieving the PA target (>150 min of moderate-to-vigorous-intensity PA/week) and biopsychosocial characteristics were assessed using univariable logistic regression analyses. Results. Mean age was 67 years and 24% were women. Participants achieving the PA target (76%) were more likely to have higher levels of social support, higher outcome expectations for PA, and higher intrinsic regulation (motivation, p < .05 for all). Those not achieving the PA target (24%) had a higher proportion of sedentary time, fewer steps/day, and were more likely to be older, retired, and have reduced left ventricular ejection fraction (LVEF) (p < .05 for all). Conclusions. Although exCR participation provides exercise routines, one-fourth of individuals did not reach the guideline-directed PA targets after an ACS. In addition to higher age and reduced LVEF, lower levels of social support, outcome expectations, and motivation were associated with low levels of PA. Exploring these factors could be of importance to support individuals' behavior change toward increased PA during the exCR period.

The benefits of cardiac rehabilitation (CR) have been demonstrated in patients after myocardial infarction (MI), and in patients with chronic heart failure (HF). The core components of the CR program include improvement in exercise tolerance and optimization of coronary risk factors (i.e., lipid and lipoprotein profiles, body weight, blood glucose levels, blood pressure levels, and smoking cessation). Indeed, CR has been shown to improve exercise capacity, control of cardiovascular risk factors, quality of life, hospital readmission, and mortality rates. Nonetheless, pre- and clinical CR and exercise training models are an enormous source of potential beneficial mechanisms that can be exploited for cardiac disease therapy. Consequently, in this review, we aim to explore the unique benefits of CR in HF and coronary artery disease, focusing on the epigenetic mechanisms involved and their translational relevance. These mechanisms may represent novel therapeutic targets to promote functional recovery after cardiac injury, and non-coding RNAs could be predictive biomarkers for CR success in patients.

Maintaining a satisfactory level of physical activity (PA) after cardiovascular rehabilitation in patients with coronary heart disease (CHD) is an important public health issue. However, more than half of patients do not maintain recommended levels of PA in the long term. There is growing interest in the use of cognitive-behavioural interventions that actively involve both health professionals and patients in education and research settings. We hypothesise that a personalised therapeutic education programme (PTEP) delivered by peers in collaboration with health professionals may help patients with CHD maintain appropriate levels of PA after participation in a cardiovascular rehabilitation programme (CRP).

We designed a prospective randomised controlled trial (the P-HEART-NER study) conducted jointly by health professionals and patients as experts or peers. The primary objective is to assess the impact of PTEP on objective levels of moderate to vigorous PA-measured by accelerometers-6 months after cessation of CRP. The secondary objectives are (1) to assess the impact of the intervention on light PA and sedentary time (also measured by accelerometry), (2) to evaluate changes in cardiovascular health indicators, including blood pressure, waist circumference and lipid profile, (3) to assess changes in motivation towards PA (using the Motivation Scale Towards Health-Oriented Physical Activity), PA self-efficacy (measured by the Exercise Confidence Survey) and quality of life (EQ-5D-5L). Patients will be enrolled at the end of a 4-week phase 2 CRP after a myocardial infarction. The intervention will consist of two teleconsultations and a group workshop at 2, 4 and 5 months, respectively, each jointly delivered by a peer and a health professional. The peers who will deliver the intervention will be patients who have participated in a phase 2 CRP with good compliance and who will be trained in motivational enhancement and cognitive behavioural therapies by health professionals and expert patients. The control group will not complete the PTEP.

Ethical approval was granted by the French regional ethics committee CPP Ile de France (Ref CPPIDF1-2023-DI36-Cat2). All participants will sign a written informed consent form. The results will be presented at conferences and published in peer-reviewed journals.

NCT05927363.

International guidelines emphasize the importance of preventive efforts after early-onset myocardial infarction (EOMI); however, data on "real-world" long-term risk factor management and adverse event rates in this special patient group is scarce.

In this German registry study, 301 patients with MI aged ≤ 45 years were investigated. Risk factor control was assessed at the time of index MI and after 1 year. Major adverse cardiac and cerebrovascular events (MACCE) and its predictors were analyzed during long-term follow-up (median duration 49 months).

A majority of patients with EOMI presented with insufficient risk factor control, even during 1-year follow-up. After 1-year 42% of patients were persistent smokers; 74% were physically inactive. The rate of obesity increased significantly from index MI (41%) to 1-year follow-up (46%, p = 0.03) as well as the rate of dysglycemia (index MI: 40%; 1-year follow-up: 51%, p < 0.01) and diabetes mellitus (index MI: 20%; 1-year follow-up: 24%, p < 0.01). 66% of the patients with diabetes mellitus had unsatisfactory HbA1c after 1 year; 69% of the patients did not attain guideline-recommended lipid targets. The rate of MACCE during long-term follow-up was 20% (incidence rate 0.05 per person-year). In a multivariable analysis smoking (HR 2.2, HR 1.3-3.7, p < 0.01) and physical inactivity (HR 2.8, HR 1.2-6.7, p = 0.02) were significant predictors for the occurrence of MACCE.

Insufficient long-term risk factor control was common in patients with EOMI and was associated with an elevated rate of MACCE. The study reveals that better strategies for prevention in young patients are crucially needed.

Exercise-based Cardiac Rehabilitation (EBCR) is widely recognized as a crucial intervention for improving the health outcomes of patients with coronary artery disease (CAD). However, its implementation remains insufficient in many regions, and patient adherence to EBCR is generally low. This limitation hinders the full potential of rehabilitation, necessitating a deeper exploration of the factors influencing exercise adherence and the development of targeted intervention strategies.

This study aims to identify the barriers and facilitators affecting ERCR adherence among CAD patients and provide intervention recommendations for clinical practice.

A systematic search was conducted across nine databases, including PubMed, Cochrane Library, Embase, Web of Science, EBSCO, CNKI, Wanfang, VIP, and CBM. Using the Theoretical Domains Framework and the COM-B model, a thematic analysis was performed to categorize influencing factors identified in the included studies. These factors were mapped onto the Behaviour Change Wheel, and the APEASE criteria were applied to determine appropriate intervention functions. Finally, Behaviour Change Techniques were matched to these intervention functions.

Seventeen studies were included, identifying multiple core domains of the Theoretical Domains Framework influencing EBCR adherence. The most significant domains were social influences, beliefs about consequences, and environmental context and resources. The primary barrier was patients' negative attitudes toward EBCR, whereas the most prominent facilitator was a strong social support network.

This study systematically analyzed the determinants of EBCR adherence based on the Theoretical Domains Framework and COM-B model, constructing theoretically supported intervention strategies and providing new insights for optimizing EBCR implementation. Through precise Behaviour Change Techniques mapping, the proposed personalized interventions can enhance patients' motivation for rehabilitation, improve EBCR adherence, and offer empirical support for future EBCR intervention design and implementation.

To assess the impact of a nurse-led remote secondary cardiovascular prevention programme versus usual follow-up in patients who have suffered an acute coronary syndrome in terms of major adverse clinical events (MACE), diet, physical exercise, smoking, emotional state, adherence to medical treatment, cardiometabolic profile and anthropometric parameters within one year of discharge.

Prospective, randomised, open-label, evaluator-blinded, multicentre trial.

Between October 17, 2017, and February 5, 2023, patients were randomly assigned to either a usual follow-up of two cardiology visits over 12 months or the nurse-led remote secondary cardiovascular prevention programme, which also included 5 nursing visits (one face-to-face and four remote).

At 12 months, the nurse-led remote prevention programme group (interventional group) had lower smoking rates, greater adherence to medication, greater adherence to the Mediterranean diet, more physical activity, and better perceived health status compared to the usual follow-up group. The interventional group demonstrated a reduction in major adverse clinical events (20.7%) compared to the usual follow-up group (12.4%). This reduction was observed particularly in Acute Coronary Syndrome recurrence, all-cause hospitalisation, and hospitalisation for cardiovascular causes.

Patients randomised to the nurse-led remote prevention programme showed a significant reduction of the MACE, improved lifestyle, and medication adherence at 12 months compared to the usual follow-up group.

This study illustrates the feasibility and efficacy of a remote secondary cardiovascular prevention programme led by advanced practice nurses in patients who have suffered an Acute Coronary Syndrome.

CONSORT.

None.

The study was prospectively registered at www.

gov: NCT03234023.

Atherosclerotic plaques represent a typical deterioration of arterial wall in atherosclerotic process and are the source of cardiovascular events. Plaque progression and composition represent a major risk for cardiovascular events. Therefore, recently many studies have assessed changes in plaque characteristics and their response to various treatment modalities. In the last two decades, improvement in plaque imaging modalities that can assess plaque volumes and composition enable to follow plaque characteristics in a non-invasive way. Clinical trials utilizing arterial imaging modalities have shown that reducing LDL cholesterol to low levels can reduce atherosclerotic plaque burden and favourably modify plaque composition. These outcomes have been achieved with statin therapy and newer lipid-lowering strategies such as protein convertase subtilisin/kexin type 9 inhibitors. Also, some anti-inflammatory drugs and other anti-atherosclerotic medications can lead to significant reduction in plaque burden. However, the data assessing association of plaque regression to reduction of cardiovascular events are limited. Therefore, the aim of this narrative review is to elucidate the possibilities and the role of plaque assessment and if it might offer the potential to guide personalized management of patients at risk for cardiovascular events in the future.

This review explores the critical role of exercise as a non-pharmacological intervention in managing ischemic cardiomyopathy (ICM), a leading cause of heart failure. It highlights the profound cardiovascular benefits of exercise, such as improved cardiopulmonary parameters, decreased morbidity and mortality, and enhanced functional capacity. It also critically evaluates existing literature on the efficacy of various exercise types and intensities, including aerobic, resistance, and high-intensity interval training. There is a significant gap in current clinical guidelines, which lack specific exercise prescriptions tailored to the unique pathophysiology of ICM. By synthesizing data from both older and contemporary studies, this review highlights specific, evidence-based exercise regimens and promotes supervised cardiac rehabilitation programs. This review also addresses potential barriers to cardiac rehabilitation participation and proposes future directions, which include the use of technology to improve adherence and outcomes.

This research aimed to unveil the effects of real-time three-dimensional echocardiography (RT-3DE) combined with radionuclide imaging to evaluate changes in cardiac function and synchronization before and after cardiac rehabilitation in patients with acute myocardial infarction (AMI).

RT-3DE and radionuclide imaging were performed after PCI (pre-rehabilitation) and the 8-week follow-up visit (post-rehabilitation). Relevant data were collected: heart rate (HR), left ventricular (LV) end-systolic volume (LVESV), LV end-diastolic volume (LVEDV), LV ejection fraction (LVEF), LV 16-segment maximum difference in time to minimum systolic volume (Tmsv-16-Dif), LV 16-segment standard deviation of time to minimum systolic volume (Tmsv-16-SD), Tmsv 16-Dif % and Tmsv 16-SD %, summed Stress Score (SSS), Summed Rest Score (SRS), and SDS (SRS-SSS).

At the 8-week follow-up after PCI, HR, LVEDV, LVESV, Tmsv-16-Dif, Tmsv-16-SD, Tmsv-16-Dif%, Tmsv-16-SD%, SSS, SRS, and SDS in the rehabilitation group were lower than those in the control group; LVEF in the rehabilitation group was higher than the control group.

RT-3DE and radionuclide imaging can be used as a follow-up tool for evaluating LV function and synchronization changes after cardiac rehabilitation in patients with AMI undergoing PCI.

Cardiac rehabilitation (CR) is standard care for patients after a heart event, including acute myocardial infarction. However, the uptake and relevance of traditional CR after acute myocardial infarction due to spontaneous coronary artery dissection (SCAD) has not been extensively investigated. The present study investigated attitudes toward CR, identified the rate and correlates of CR attendance, and examined the reasons for CR non-attendance after SCAD.

Online focus groups (n = 30) explored attitudes toward and experiences of CR of survivors of SCAD, with data analyzed thematically according to recommended guidelines. An online survey (n = 310) then investigated rates of CR attendance and reasons for non-attendance. Correlates of CR attendance were identified using bivariate and multivariable analyses.

Thematic analysis revealed 5 themes in the perceptions of CR of survivors of SCAD: (1) lack of relevance of CR educational content; (2) lack of identification with typical CR attendees; (3) lack of CR health professional knowledge and skills; (4) preference for SCAD-specific CR; and (5) benefits of CR. The survey demonstrated a CR attendance rate of 63% (73% among those referred). The correlates of CR attendance were mid-level education and self-reported lifetime anxiety. Among attendees, the correlates of attending fewer sessions were having a more recent SCAD, not having lifetime anxiety, and not knowing other survivors of SCAD. Reported reasons for non-attendance mirrored qualitative themes identified.

While the survey demonstrated high CR attendance, perceptions that CR was unnecessary and irrelevant after SCAD were evident, often based on health professional advice. The findings add to the growing literature highlighting a need for appropriate support for survivors of SCAD.

Cardiac rehabilitation (CR) improves health outcomes in patients with cardiovascular disease (CVD), but referral, participation, and completion rates are low. Home-based CR (HBCR) is a proposed solution, but studies on its efficacy are limited. We report our experience from a Veterans Affairs HBCR program on physical function, costs, and outcomes overlapping with the coronavirus disease-2019 (COVID-19) pandemic.

A 12-week HBCR program included case-managed individualized exercise and risk management. Six functional tests were conducted remotely, safety was monitored, and quality of life and costs were quantified. A composite outcome (death, myocardial infarction, stroke, and cardiac-related hospitalization) was compared between 70 HBCR participants, 131 patients referred to Community Care, and 71 patients undergoing usual care (no CR) over a mean follow-up of 2.5 ± 0.90 years.

Among HBCR participants, there were significant improvements in right and left leg balance (145 and 56%, respectively, P < .001), 30-second chair stand (47%, P < .001), 2-minute step performance (41%, P < .001), right and left 30-second arm curl (31 and 30%, respectively, P < .001), 50-foot walk test (20%, P = .002), 8-foot up and go test (28%, P < .001), and steps/day (82%, P < .001). Composite events were lower among patients in the HBCR group versus those referred to Community Care ( P = .002). Health care costs were significantly lower among patients in the HBCR group compared to those in Community Care ($2101 vs $3289/subject, P < .001).

A HBCR program that included a broad spectrum of patients with CVD and multiple co-morbidities, performed largely during the COVID-19 pandemic, resulted in significant functional and outcome benefits and reduced costs.

Physical activity (PA) declines with age, with chronic health conditions a contributing factor. Exercise motivation (EM), a factor of PA adherence, may be promoted through community program participation. The purpose was to investigate the effect of health conditions and community program participation on PA and EM. Surveys comprising of demographics, physical activity (PASE), and exercise motivation (BREQ-2), were distributed. Significant differences were found for PA between community program participants with and without a health condition. A significant main effect for health condition existed on several subscales of EM: identified regulation and intrinsic regulation, and for obesity on amotivation, identified regulation, and intrinsic regulation. Significant differences existed between community exercise program participants (N = 77) and non-participants (N = 145) for amotivation (p < 0.001), identified regulation (p < 0.001), and intrinsic regulation (p < 0.001). The presence of a health condition appears to impact EM. Community program participation positively influenced EM, potentially negating the effect of health condition.

As wearable technologies have become increasingly affordable, accessible, and practical, an increasing number of people with cardiovascular disease are beginning to use consumer-grade devices. Common health and wellness metrics reported by wearable devices include heart rate, heart rhythm, and step count, which may afford opportunities to assess cardiovascular conditions, prescribe more personalized exercise for enhanced engagement, and monitor physical activity adherence in patients with cardiovascular disease. This narrative review discusses the application of wearable devices in patients with coronary artery disease, heart failure, atrial fibrillation (AF), cardiac implantable electric devices, and peripheral artery disease in different cardiovascular rehabilitation settings (eg, supervised and home-based). Available literature suggests that, when combined with telemonitoring, wearable devices can increase physical activity participation, thereby improving peak oxygen consumption (V ˙ O2peak) and quality of life (QoL) in patients with coronary artery disease, enhancing physical function and QoL in patients with heart failure, and increasing walking capacity andV ˙ O2peak in patients with peripheral artery disease. Wearable devices can also detect AF vs sinus rhythm, guide exercise timing in patients with AF, and monitor safe exercise intensity in patients equipped with cardiac implantable electric devices. Healthcare professionals can promote physical activity by incorporating wearable devices, which can help motivate device users by providing real-time feedback on their behaviours. Commercially available wearable devices have the potential to enhance engagement in physical activity, thereby augmenting the established effects of exercise programs onV ˙ O2peak, functional capacity, and QoL in patients with various cardiovascular conditions.

Exercise training is a core component of cardiac rehabilitation (CR) programming. Exercise and, more broadly, physical activity are critical elements to secondary prevention of cardiovascular disease. The central components of the exercise prescription are well-defined and include frequency (how many bouts of exercise per week), intensity (how hard to exercise), time (duration of exercise session), type (modality of exercise), and progression (rate of increase in the dose of exercise). Specific targets for the volume (total amount) of exercise, however, are less well-defined. This Position Statement provides a general overview of the specific goals for the volume of aerobic exercise to optimize long-term outcomes for participants in CR. Additionally, examples are provided to illustrate how to integrate the various aspects of the exercise.

Chronic coronary disease (CCD) is the leading cause of death in the United States. There is an ongoing imperative to disseminate evidence-based and patient-centered care recommendations that further align the management of patients with CCD to updated evidence-based guidelines. The writing committee developed a comprehensive CCD measure set comprising 10 performance measures and 3 quality measures, the focus of which is to include practical steps to specifically advance care in the CCD population. The measure set begins with an assessment of tobacco use and evidence-based cessation interventions. Also included are topics such as antiplatelet therapy, lipid assessment and low-density lipoprotein cholesterol goals, and guideline-directed management and therapy for hypertension and reduced left ventricular dysfunction in patients with CCD. The measure set concludes with an emphasis on the importance of cardiac rehabilitation referral and patient education, including symptom management and lifestyle modification.

Background: Models of second-phase cardiac rehabilitation (CR) following myocardial infarction (MI) differ across countries. The aim of this study was to compare outcomes in MI survivors participating in outpatient and inpatient CR programs. Methods: All patients hospitalized for acute MI in Poland between October 2017 and December 2018 (n = 96,634) were included in the study. Among them, 4411 patients were referred to and commenced outpatient CR, whereas 11,626 patients started inpatient CR within 30 days following discharge. Results: The mean follow-up period was 332.8 ± 128.1 days. Younger age, male sex, and a history of cancer were associated with a higher probability of participating in outpatient CR, whereas diabetes, heart failure, chronic kidney disease, chronic obstructive pulmonary disease, ST-elevation MI, and myocardial revascularization were associated with a lower likelihood of outpatient CR participation. Participation in outpatient CR was linked to a reduced risk of all-cause mortality, in both univariable (hazard ratio [95% confidence interval]: 0.37 [0.26-0.51]) and multivariable analyses (0.53 [0.38-0.74]). Outpatient CR was also associated with a lower risk of death, MI, or stroke (0.57 [0.48-0.67] in univariable analysis and 0.72 [0.61-0.84] in multivariable analysis), as well as a lower risk of death or cardiovascular hospitalization (0.78 [0.73-0.84] and 0.85 [0.80-0.91], respectively). Conclusions: Outpatient CR following MI tends to occur alongside a better prognosis compared to inpatient programs.

Chronic coronary disease (CCD) is the leading cause of death in the United States. There is an ongoing imperative to disseminate evidence-based and patient-centered care recommendations that further align the management of patients with CCD to updated evidence-based guidelines. The writing committee developed a comprehensive CCD measure set comprising 10 performance measures and 3 quality measures, the focus of which is to include practical steps to specifically advance care in the CCD population. The measure set begins with an assessment of tobacco use and evidence-based cessation interventions. Also included are topics such as antiplatelet therapy, lipid assessment and low-density lipoprotein cholesterol goals, and guideline-directed management and therapy for hypertension and reduced left ventricular dysfunction in patients with CCD. The measure set concludes with an emphasis on the importance of cardiac rehabilitation referral and patient education, including symptom management and lifestyle modification.

Cardiac telerehabilitation (CTR) interventions can provide accessible and affordable remote rehabilitation services. However, as cardiac rehabilitation (CR) primarily targets inactive patients, little is known about the experiences with CR of highly active patients (ie, recreational athletes or, simply, athletes) with established coronary artery disease. Consequently, existing CTR interventions do not address the specific needs of the athletic subpopulation. Understanding the needs and values of athletes is crucial for designing meaningful CTR interventions that enhance user acceptance and engagement, thereby facilitating effective rehabilitation for this patient subgroup.

This study aimed to inform the design of technologies that facilitate CTR for athletes. We intended to identify athletes' values related to CR, including health and sports tracking, as well as high-level requirements for technologies that can facilitate the CTR of athletes according to the identified values.

We used value-sensitive design with a human-centric design approach to elicit design requirements for CTR that can serve athletes with established coronary artery disease. To identify athletes' values, we conducted 25 value-oriented semistructured interviews with 15 athletic patients and 10 health care professionals involved in CR programs. In a second phase, we conducted 6 card-sorting focus group sessions with 13 patients and 7 health care professionals to identify desired CTR features. Finally, we derived high-level CTR technology requirements connected to the athletes' needs and values.

We defined 12 athlete values divided into 3 categories: body centric, care centric, and data and technology centric. We clustered findings from the card-sorting activity into CTR technology requirements, such as remotely monitored sport-specific training and training data representations next to clinical limitations, and paired them with corresponding values.

Athletes have distinct values and health goals in CR compared to general populations targeted by CTR interventions. Designing patient-centric CTR interventions that address these needs is crucial to support optimal recovery, safe return to sports, and adherence to CTR technologies in the home environment.

The "2025 ACC/AHA/ACEP/NAEMSP/SCAI Guideline for the Management of Patients With Acute Coronary Syndromes" incorporates new evidence since the "2013 ACCF/AHA Guideline for the Management of ST-Elevation Myocardial Infarction" and the corresponding "2014 AHA/ACC Guideline for the Management of Patients With Non-ST-Elevation Acute Coronary Syndromes" and the "2015 ACC/AHA/SCAI Focused Update on Primary Percutaneous Coronary Intervention for Patients With ST-Elevation Myocardial Infarction." The "2025 ACC/AHA/ACEP/NAEMSP/SCAI Guideline for the Management of Patients With Acute Coronary Syndromes" and the "2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization" retire and replace, respectively, the "2016 ACC/AHA Guideline Focused Update on Duration of Dual Antiplatelet Therapy in Patients With Coronary Artery Disease."

A comprehensive literature search was conducted from July 2023 to April 2024. Clinical studies, systematic reviews and meta-analyses, and other evidence conducted on human participants were identified that were published in English from MEDLINE (through PubMed), EMBASE, the Cochrane Library, Agency for Healthcare Research and Quality, and other selected databases relevant to this guideline.

Many recommendations from previously published guidelines have been updated with new evidence, and new recommendations have been created when supported by published data.

This study aimed to explore the barriers to cardiac rehabilitation (CR) participation across individuals with different levels of health literacy. A cross-sectional study was conducted among individuals referred to a CR program. Participants completed online surveys assessing CR barriers using the Cardiac Rehabilitation Barriers Scale and health literacy using the Brief Health Literacy Screening Tool. Descriptive statistics and comparisons were performed. Among 881 individuals invited, 400 responded, with varying levels of health literacy: 22(6%) limited, 305(76%) marginal, and 72(18%) adequate. The greatest barriers included family responsibilities, lack of energy, and a preference for managing health alone. However, distinct patterns emerged based on health literacy levels, with individuals citing different barriers. Although no significant differences were observed in CR barriers based on health literacy, understanding individual-specific challenges is crucial for intervention development. Addressing common barriers such as family responsibilities and logistical challenges could enhance CR engagement and adherence. [HLRP: Health Literacy Research and Practice. 2025;9(2):e72-e77.].

To inform the delivery of cardiac rehabilitation (CR) care nationwide at the hospital level, we described hospital-level variation in CR metrics, overall and stratified by the hospital's tier of cardiac care provided.

This retrospective cohort analysis used Medicare fee-for-service (FFS) data (2018-2020), Parts A and B, and American Hospital Association (AHA) data (2018). We included beneficiaries with an acute myocardial infarction (AMI), percutaneous coronary intervention (PCI), or coronary artery bypass graft (CABG) in 2018, aged ≥65 years, and continuously enrolled in a FFS plan. We calculated hospital-level metrics for hospitals with ≥20 CR-qualifying events, which were identified using diagnostic/procedure codes. Claims for CR were identified by Healthcare Common Procedure Coding System (HCPCS) codes. We used multi-level models to examine patient- and hospital-level factors associated with CR metrics. Hospitals were stratified by tier of cardiac care provided (comprehensive, AMI/PCI, AMI-only care).

Across the US, 2,212 hospitals treated individuals aged ≥65 years with a CR-qualifying event in 2018. By tier of cardiac care, 44.4% of hospitals provided comprehensive care, 31.2% provided AMI/PCI care, and 24.4% provided AMI-only care. Across all hospitals, there was substantial variation in CR enrollment (median 19.6%, interquartile range [IQR] = 7.0%, 32.8%). Among hospitals with enrollment (n = 1,866), median time to enrollment was 55.0 days (IQR = 41.0, 71.0), median number of CR sessions was 26.0 (IQR = 23.0, 29.0), and median percent completion was 26.0% (IQR = 10.5%, 41.2%). There was also substantial variation in CR performance metrics among hospitals within each tier of cardiac care (eg, median percent CR enrollment was 30.7% [IQR = 20.7%-41.3%] among comprehensive care hospitals, 18.6% [IQR = 9.5%-27.7%] among AMI/PCI hospitals, and 0.0% [IQR = 0.0%-7.7%] among AMI-only hospitals). In adjusted analyses, characteristics associated with lower odds of CR enrollment included patient-level factors (older age, female sex, non-White race or ethnicity), and hospital-level factors (for-profit ownership, regions other than the Midwest, rural location, medium/large hospital size).

This is the first national, hospital-level analysis of CR metrics among Medicare beneficiaries. Substantial variation across hospitals, including peer hospitals within the same tier of cardiac care, indicates opportunities for hospital-level quality improvement strategies to improve CR referral and participation metrics.

Refractory angina (RA) is a debilitating condition characterized by persistent angina despite optimized medical therapy and limited options for further revascularization, leading to diminished quality of life and increased healthcare utilization. The RA patient population is rapidly expanding with significant unmet needs. Specialty clinics should be developed to focus on the long-term efficacy and safety of clinically available and novel treatment strategies, emphasizing quality of life.

Patient-focused Comprehensive Angina Relief (CARE) clinics can enhance care and outcomes by providing individualized management for complex RA. This review summarizes peer-reviewed articles from PubMed and trial data from ClinicalTrials.gov. We discuss the epidemiology and pathophysiology of RA, introduce standardized tools for evaluating angina and psychosocial factors, and address symptom management. We also review treatment options such as risk factor modification, medication, and complex revascularization. Additionally, we explore emerging therapies, including coronary sinus occlusion, regenerative therapy, and neuromodulation for 'no-option' RA.

In the next five years, patients with refractory chest pain with or without coronary artery disease will increasingly be referred to specialty clinics for follow-up. Conducting more randomized control clinical trials with larger population subsets will bring novel therapies to the forefront.

Angina pectoris, a primary manifestation of ischemic heart disease, imposes a significant clinical and economic burden globally. This review highlights recent advancements in the management of angina, emphasizing a patient-centred approach that integrates pharmacological, interventional, and lifestyle strategies to reduce cardiovascular risk and improve patient outcomes. For obstructive coronary artery disease, optimal medical therapy represents the cornerstone of treatment. Individualized regimens should be tailored to clinical factors such as blood pressure, heart rate, left ventricular function, comorbidities like heart failure and diabetes, concomitant medications, patient preferences, and drug availability. Myocardial revascularization is reserved for select cases to alleviate symptoms or improve prognosis. For angina or ischemia with non-obstructive coronary arteries (ANOCA/INOCA), precise endotype classification, differentiating microvascular angina, vasospastic angina, mixed type and non-coronary chest pain, enables personalized treatment strategies. Lifestyle interventions, including smoking cessation, weight management, adherence to Mediterranean diet, and exercise therapy, are essential components of care, promoting improved cardiovascular outcomes and quality of life. Structured exercise programs, particularly within cardiac rehabilitation settings, have demonstrated efficacy in enhancing functional capacity and reducing adverse events. Emerging therapies, including pharmacological agents and novel interventional approaches such as the coronary sinus reducer, hold promise for addressing unmet needs in refractory angina and challenging ANOCA/INOCA cases. Future directions should prioritize the integration of precision medicine, digital health technologies, and multidisciplinary care to optimize outcomes and advance personalized angina management.

Coronary heart disease (CHD) is a pervasive chronic condition that poses a significant threat to global health and mortality worldwide. Given the severity of this disease, it is imperative to consider pivotal factors such as age, concurrent diseases, and physical frailty of patients diagnosed with ischemic non-obstructive CHD prior to initiating cardiopulmonary rehabilitation. Consequently, the objective of this study is to investigate the impact of an individualized exercise rehabilitation program, on the ischemic burden in patients suffering from ischemic non-obstructive CHD.

From February 2019 to July 2021, a cohort of one hundred patients diagnosed with ischemic non-obstructive CHD were recruited and randomly allocated into two groups. The control group underwent a standard rehabilitation program, while the intervention group participated in an individualized exercise rehabilitation program. This program was tailored to each patient, with a 50% power intensity exercise prescription derived from the results of the patient's Cardiopulmonary Exercise Testing (CPET) evaluation. The therapeutic effect, total myocardial ischemic burden (TIB), the effective rate of TIB reduction, pulmonary function indices, cardiac function, and the incidence of adverse events compared between the two groups.

The intervention group demonstrated a higher effective rate. TIB in the intervention group was significantly reduced at the 1,2, and 4-week marks post-intervention and exhibited a higher effective rate of total myocardial ischemia load reduction. Post-intervention, there were improvements in the Forced Vital Capacity (FVC), Forced Expiratory Volume in one second (FEV1), and the FEV1/FVC ratio, with the intervention group showing higher values for these parameters. Cardiac function was enhanced following the intervention, with the intervention group displaying higher Left Ventricular Ejection Fraction (LVEF) and Carbon Monoxide (CO) levels, and a lower Left Ventricular End-Diastolic Dimension (LVEDD) compared to the control group (P < 0.05).

An individualized exercise rehabilitation regimen for patients diagnosed with ischemic non-obstructive CHD can effectively compensate for the lack of physical activity. This regimen has demonstrated its ability to enhance the clinical therapeutic effect, reduce the total load of myocardial ischemia, improve pulmonary function indices and cardiac function, and decrease the incidence of cardiovascular adverse events.

identifier (TJ-IRB20210716).

Cardiac rehabilitation (CR) can improve cardiovascular health. We identified whether CR participation was associated with fewer subsequent inpatient hospitalizations and emergency department visits and less Medicare and out-of-pocket expenditures, and whether outcomes varied by amount of participation.

This retrospective study used Medicare fee-for-service claims data, including beneficiaries with a CR-qualifying event in 2016. Participants attended ≥2 sessions of CR within 365 days of the event. Propensity score matching was used to identify CR-eligible nonparticipants. Difference-in-differences analyses were used to compare differences in outcomes before (2014-2015) and after (2018-2019; 2-year CR period=2016-2017) the CR period between participants and nonparticipants.

We identified 57 668 CR-eligible beneficiaries after matching, with equal numbers of participants and nonparticipants. Nearly 65% of beneficiaries had a percutaneous coronary intervention, 33.5% had an acute myocardial infarction, 17.5% had a coronary artery bypass graft, and 16.8% had a heart valve repair/replacement. Compared with nonparticipants, participants had 47.6 fewer subsequent annual inpatient hospitalizations per 1000 beneficiaries (95% CI, -58.8 to -36.3) and $1005 lower subsequent annual Medicare expenditures per beneficiary (95% CI, -$1352 to -$659). Compared with no participation, medium participation (12-23 sessions), high participation (24-35 sessions), and CR completion (≥36 sessions) were associated with fewer inpatient hospitalizations and lower Medicare expenditures per year.

CR was associated with fewer subsequent annual inpatient hospitalizations and lower subsequent annual Medicare expenditures. A higher amount of participation was associated with a further reduction in hospitalizations and expenditures. These findings can inform programs and policies that encourage CR participation.

Intention is an important factor in encouraging patients to receive cardiac rehabilitation. Illness perceptions of patients and individuals around them, such as family caregivers, may influence intention. However, no study has explored how family caregivers' illness perceptions enhance older coronary heart disease (CHD) patients' phase II cardiac rehabilitation intentions.

To describe older CHD patients' phase II cardiac rehabilitation intentions and their relationship with family caregivers' illness perceptions and to examine the mediating role of patients' illness perceptions.

A descriptive cross-sectional study was conducted among 202 older CHD patient‒family caregiver dyads. The Chinese versions of the Revised Illness Perception Questionnaire, Willingness to Participate in Cardiac Rehabilitation Questionnaire (WPCRQ), and Cardiac Rehabilitation Inventory (CRI) were adopted. Data analysis included descriptive statistics, Pearson correlations, and structural equation modeling. Reporting followed the STROBE checklist.

Patients were 69.81 years and mostly male (64.85 %); family caregivers were 52.58 years and mostly female (55.94 %). Family caregivers' personal control had a direct effect on patients' phase II cardiac rehabilitation intentions (βWPCRQ = -0.217, βCRI = -0.228; P = 0.001). Family caregivers' personal control, treatment control, and timeline acute/chronic had indirect effects on patients' cardiac rehabilitation intentions through patients' corresponding dimensions of illness perceptions (|β|WPCRQ = 0.086∼0.098, |β|CRI = 0.062∼0.097; P < 0.05).

Family caregivers' illness perceptions can affect patients' phase II cardiac rehabilitation intentions directly and indirectly through patients' illness perceptions. Interventions targeting illness perceptions in both older CHD patients and their family caregivers could be provided to improve patients' phase II cardiac rehabilitation intentions.

To quantify the added clinical benefit of a healthy lifestyle following an acute coronary syndrome (ACS). Our study seeks to answer the question: Is adherence to medical therapy sufficient or a healthy lifestyle provides additional improvement?.

This is a prospective observational multi-center study of 685 ACS patients. At 6 months patients were asked about their post-ACS lifestyle and were given a score (range: 0-7) with the following items: Intake of ≥3 fruits and vegetables/day, ≥2 fish servings/week, ≤7 alcohol beverages/week, feeling stress

Results

After adjusting for demographic variables, cardiovascular risk factors, characteristics of the index event, high-sensitivity C-reactive protein (hs-CRP), and drug therapy, multivariate Cox regression showed that the lifestyle SCORE was independently and inversely associated with both the incidence of the primary outcome (ischemic events [any ACS, stroke, or Transient Ischemic Attack] or death) (HR 0.65 (CI95 % 0.44-0.96); p = 0.029) and death (HR 0.41 [95 %CI 0.18-0.91]; p = 0.029). Statin therapy was also independently and inversely associated with the incidence of the primary outcome and death. Kaplan-Meier curves showed a higher event-free survival for both outcomes in patients with SCORE≥4 (healthy lifestyle) than in those with SCORE<4 (unhealthy lifestyle). Additionally, patients with a SCORE≥4 had a significantly greater decrease of total cholesterol and hs-CRP. For each 1-point increase in the score, there was a 35 % reduction in the incidence of the primary outcome (ischemic events or death) and a 59 % reduction in the incidence of death.

Conclusion

Among patients with ACS and similar medical therapy, a healthy lifestyle is an independent and added marker of a lower incidence of new ischemic events and death. It is also associated with a better lipid profile and lower inflammation after the ACS. As the prognosis of ACS has improved over the years due to better therapies; this study shows that lifestyle modifications continue to offer significant benefit at this point in time.

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Modulating immune function is a critical strategy in cancer and atherosclerosis treatments. For cancer, boosting or maintaining the immune system is crucial to prevent tumor growth. However, in vascular disease, mitigating immune responses can decrease inflammation and slow atherosclerosis progression. Anti-inflammatory therapy, therefore, presents a unique dilemma for cancer survivors: while it may decrease cardiovascular risk, it might also promote cancer growth and metastasis by suppressing the immune response. Senescence presents a potentially targetable solution to this challenge; senescence increases the risk of both cancer therapy resistance and vascular disease. Exercise, notably, shows promise in delaying this premature senescence, potentially improving cancer outcomes and lowering vascular disease risk post-treatment. This review focuses on the long-term impact of cancer therapies on vascular health. We underscore the importance of modulating senescence to balance cancer treatment's effectiveness and its vascular impact, and we emphasize investigating the role of exercise-mediated suppression of senescence in improving cancer survivorship.

The "2025 ACC/AHA/ACEP/NAEMSP/SCAI Guideline for the Management of Patients With Acute Coronary Syndromes" incorporates new evidence since the "2013 ACCF/AHA Guideline for the Management of ST-Elevation Myocardial Infarction" and the corresponding "2014 AHA/ACC Guideline for the Management of Patients With Non-ST-Elevation Acute Coronary Syndromes" and the "2015 ACC/AHA/SCAI Focused Update on Primary Percutaneous Coronary Intervention for Patients With ST-Elevation Myocardial Infarction." The "2025 ACC/AHA/ACEP/NAEMSP/SCAI Guideline for the Management of Patients With Acute Coronary Syndromes" and the "2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization" retire and replace, respectively, the "2016 ACC/AHA Guideline Focused Update on Duration of Dual Antiplatelet Therapy in Patients With Coronary Artery Disease."

A comprehensive literature search was conducted from July 2023 to April 2024. Clinical studies, systematic reviews and meta-analyses, and other evidence conducted on human participants were identified that were published in English from MEDLINE (through PubMed), EMBASE, the Cochrane Library, Agency for Healthcare Research and Quality, and other selected databases relevant to this guideline.

Many recommendations from previously published guidelines have been updated with new evidence, and new recommendations have been created when supported by published data.

Coronary artery disease and aortic valve stenosis are highly prevalent cardiovascular diseases worldwide, resulting in substantial morbidity and mortality. Surgical interventions, such as coronary artery bypass grafting and surgical aortic valve replacement, offer significant therapeutic benefits, including enhanced postoperative quality of life (QoL) and functional capacity, which are key indicators of surgical success. This editorial reviews recent studies on postoperative QoL and functional outcomes in patients undergoing cardiac surgery. Factors such as preoperative health, age, intensive care unit stay duration, surgical risk, and perioperative complications could influence these outcomes. Cardiac rehabilitation is pivotal in enhancing patient function, reducing frailty and improving long-term QoL.

Lung cancer ranks as the leading cause of cancer-related deaths. For lung cancer survivors, cardiopulmonary fitness is a strong independent predictor of survival, while surgical interventions impact both cardiovascular and pulmonary function. Home-based cardiac telerehabilitation through wearable devices and mobile apps is a substitution for traditional, center-based rehabilitation with equal efficacy and a higher completion rate. However, it has not been widely used in clinical practice.

The objective of this study was to broaden the use of digital health care in the cardiopulmonary rehabilitation of lung cancer survivors and to assess its impact on cardiopulmonary fitness and quality of life (QOL).

Early-stage nonsmall cell lung cancer survivors aged 18-70 years were included. All the participants received surgery 1-2 months before enrollment and did not require further antitumor therapy. Participants were randomly assigned to receive cardiac telerehabilitation or usual care for 5 months. Artificial intelligence-driven exercise prescription with a video guide and real-time heart rate (HR) monitoring was generated based on cardiopulmonary exercise testing. Aerobic exercise combining elastic band-based resistance exercises were recommended with a frequency of 3-5 d/wk and a duration of 90-150 min/wk. The effective exercise duration was recorded when patients' HR reached the target zone (HRresting + [HRmax - HRresting] × [≈40%-60%]), representing the duration under the target intensity. The prescription used a gradual progression in duration and action intensity based on the exercise data and feedback. Outcome measurements included cardiopulmonary fitness; lung function; cardiac function; tumor marker; safety; compliance; and scales assessing symptoms, psychology, sleep, fatigue, and QOL.

A total of 40 (85%) out of 47 patients finished the trial. The average prescription compliance rate of patients in the telerehabilitation group reached 101.2%, with an average exercise duration of 151.4 min/wk and an average effective exercise duration of 92.3 min/wk. The cardiac telerehabilitation was associated with higher improvement of maximal oxygen uptake peak (3.66, SD 3.23 mL/Kg/min vs 1.09, SD 3.23 mL/Kg/min; P=.02) and global health status or QOL (16.25, SD 23.02 vs 1.04, SD 13.90; P=.03) compared with usual care. Better alleviation of affective interference (-0.88, SD 1.50 vs 0.21, SD 1.22; P=.048), fatigue (-8.89, SD 15.96 vs 1.39, SD 12.09; P=.02), anxiety (-0.31, SD 0.44 vs -0.05, SD 0.29; P=.048), and daytime dysfunction (-0.55, SD 0.69 vs 0.00, SD 0.52; P=.02) was also observed in the telerehabilitation group. No exercise-related adverse events were identified during the intervention period.

The 5-month, digital therapeutics-based telerehabilitation improved cardiorespiratory fitness in lung cancer survivors with good compliance and safety. Patients receiving telerehabilitation also reported improved QOL with reduced levels of fatigue, anxiety, and daytime dysfunction.

Chinese Clinical Trial Registry ChiCTR2200064000; https://www.chictr.org.cn/showproj.html?proj=180594.

The treatment of patients with cardiogenic shock (CS) has been focused historically on single interventions (medical treatments, percutaneous and surgical interventions and, more recently, various temporary mechanical circulatory supports). However, none of these interventions has significantly changed the short-term prognosis of CS. Moreover, considerable interest in interventions applied in the acute setting has not been matched with comprehensive assessment of patients' long-term follow-up, not only for survival and rehospitalisation but also for quality of life and functional status, recovery from critical illness and its destructive sequelae, and a global evaluation of the overall sustainability of pathways of care. To fill this knowledge gap, the ENIGMA study will be conducted.

This is a prospective and retrospective multicentre registry conducted under the scientific coordination of the IRCCS Fondazione Don Gnocchi and funded by the Italian Ministry of Health (PNRR-MCNT2-2023-12377767). Data referring to 2000 patients included in the Altshock registry, the largest multicentre CS registry in Italy, will be analysed. A standardised protocol of high-intensity cardiac rehabilitation has been defined and will be followed by the involved institutions after the inclusion of the first 1000 patients. Where feasible, this new pathway will be implemented in every institution. All the patients enrolled will be evaluated according to the Long-Term Conditions Questionnaire, the Kansas City Cardiomyopathy Questionnaire and a questionnaire on the patient experience at 6-month follow-up, to evaluate real-life comparative effects on patient outcomes and experiences. In conclusion, a health technology assessment (HTA) analysis, grounded in the EUnetHTA Core Model, will be conducted to define the potential multidimensional benefits and effects with regard to the overall economic, organisational and social sustainability of the innovative dedicated pathway. Various data sources will be used to conduct the HTA: (1) literature evidence, to define the evidence-based comparative indicators considering both surgical approaches; (2) real-world anonymised data from the hospitals included in the study, to enable costing of the rehabilitative pathways; and (3) healthcare professionals' perceptions, defining the perceived added value of the innovative pathway versus the historical one, based on an evaluation scale ranging from -3 to +3.

The study was approved by the ethical committee (EC) of Lombardy Region (CET 44/24), on 28 May 2024, and is under evaluation by the EC of three other centres. The study protocol will be evaluated for ethics by 10 more centres in January 2025. Study results will be published in peer-reviewed publications and disseminated through conference presentations. The Associazione Nazionale Scompensati Cardiaci (AISC; 'National Association of Patients with Heart Failure'), the Progetto Vita initiative and the non-profit organisation 'Heart Helps Heart' have endorsed the project and will be involved in disseminating information about the project and its outcomes to the general public.

The ENIGMA-shock study has been registered at ClincialTrials.gov: NCT06572826.

Robust evidence indicates that having few or poor-quality social connections is associated with poorer physical health outcomes and risk for earlier death (Snyder-Mackler N, Science 368, 2020; Vila J, Front Psychol 12:717164, 2021).

This study sought to determine whether recent attention on social connection and loneliness brought on by the COVID-19 pandemic may influence risk perception and whether these perceptions were heightened among those who are lonely.

Two waves of online survey data were collected. The first included data from 1,486 English-speaking respondents in the US, UK, and Australia, and a second sample of 999 nationally representative US adults, with a final sample of 2392 respondents from the US and UK.

Perceptions of risk have remained consistent, underestimating the influence of social factors on health outcomes and longevity, even among respondents who reported moderate-to-severe levels of loneliness.

Despite heightened awareness and discourse during the COVID-19 pandemic, public perception in the US and UK continues to significantly underestimate the impact of social factors on physical health and mortality. This underestimation persists regardless of individual loneliness levels, underscoring the need for enhanced public education and policy efforts to recognize social connection as a crucial determinant of health outcomes.

Left ventricular global longitudinal strain (LVGLS) is a highly sensitive echocardiographic biomarker that detects signs of myocardial dysfunction. It has been proven that exercise-based cardiac rehabilitation (CR) improves LV-GLS but whether high-intensity interval training (HIIT) is more efficient than moderate-intensity interval training (MIIT) to improve LV-GLS as cardiac deformation index in cardiovascular patients is debatable. In the current systematic review and meta-analysis, different digital databases including PubMed, Scopus, Web of Science (ISI), and Google Scholar were searched systematically with no time restriction to answer the abovementioned question. Studies were included that reported GLS as the outcome in CVD subjects before and after enrolling in HIIT and/or MITT. A random effects model was used for meta-analysis. Eleven sets of results from nine articles-two of which had two sets of results-were included. The result of the sensitivity test to check the publication bias was not significant either for MIIT (p=0.211) or for HIIT (p=0.238). Our findings showed that GLS was improved significantly after both MIIT (-1.72. [-2.68, -0.77]) and HIIT (-1.86 [-3.01, -0.71]) in CVD patients; however, the effect of HIIT was greater than MIIT. Subgroup analysis results showed that baseline disease and duration of exercises do not influence the effect of training on GLS. More studies are needed to confirm the conclusion.

Patients with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI) are at high risk of thrombosis. However, bleeding-related complications during antithrombotic therapy remain a major barrier to effective treatment and can often lead to adverse outcomes. This meta-analysis aimed to determine the efficacy and safety of bivalirudin and heparin in patients with ACS after PCI.

Randomized controlled trials (RCTs) on the efficacy and safety of bivalirudin versus heparin in patients with ACS after PCI were identified from the PubMed, Embase, Cochrane Library, CBM, CNKI, WanFang, and VIP database until August 2024. The outcomes included all-cause mortality, major adverse cardiovascular events (MACEs), incidence of recurrent myocardial infarction, stent thrombosis, short-term bleeding, revascularization, and retransfusion. Meta-analysis was performed using RevMan 5.3 and Stata 12.0 softwares. The included studies were assessed for risk of bias using the Cochrane risk-of-bias assessment tool.

A total of 70,199 patients from 27 randomized controlled trials (RCTs) were analyzed in this review. There were no significant differences between the bivalirudin and heparin groups in terms of all-cause mortality, major adverse cardiovascular events (MACEs), recurrent myocardial infarction, stent thrombosis within 30 days, or subacute stent thrombosis. Specifically, the incidence of short-term bleeding (P = 0.001) and retransfusion (P = 0.001) was significantly lower in the bivalirudin group compared to the heparin group. Conversely, the incidence of acute stent thrombosis (P < 0.0001) and revascularization (P = 0.009) was significantly higher in the bivalirudin group.

Compared with heparin, bivalirudin has definite anticoagulant effect in patients with acute myocardial infarction after PCI, and the risk of bleeding and the incidence of retransfusion were lower in the bivalirudin group. This review helps doctors in PCI management choose bivalirudin or heparin more precisely based on patients' conditions for better treatment and fewer adverse events.