Search Results (811)

Atrial fibrillation (AF) is the most common clinically significant cardiac arrhythmia with a marked age-related increase in prevalence. Current guidelines recommend left atrial appendage closure (LAAC) as an alternative to long-term oral anticoagulation in selected patients at high-risk of both thromboembolic and bleeding events. Although the use of LAAC has increased substantially in recent years, its effects on cardiac function and post-procedural functional recovery remain incompletely understood. Therefore, this study aimed to evaluate changes in periprocedural cardiac function and functional parameters in patients with AF who underwent LAAC while receiving guideline-directed medical therapy. A retrospective cohort study was performed in 250 patients who underwent percutaneous LAAC at Lanzhou University Second Hospital between May 2019 and July 2025. A total of 162 patients were included in the final analysis. Echocardiographic parameters, NYHA functional class, and Barthel Index scores were compared before and after the procedure. Significant improvements were observed in several echocardiographic parameters. Post-procedural changes in NYHA functional class distribution and Barthel Index scores indicated improved functional status, with no evidence of deterioration in cardiac structure or function. These findings support the safety of LAAC with respect to cardiac functional recovery and demonstrate that the procedure does not adversely affect cardiac performance in patients with AF receiving guideline-directed medical therapy. Nevertheless, further large-scale, multi-center prospective studies are warranted to clarify the mechanisms underlying the observed improvements in cardiac function following LAAC. Full article

Balance impairment threatens mobility and independence in older adults with cardiovascular disease, yet cardiac rehabilitation (CR) has traditionally prioritised aerobic capacity and cardiovascular outcomes. This narrative review examines the mechanisms and assessment of balance impairment, balance recovery within CR, and implications for clinical practice. Balance impairment reflects interactions among musculoskeletal, sensory, cognitive–motor, and cardiovascular constraints that affect different domains of postural control to varying extents. Standardised clinical measures do not capture these domains equally, and single scores or completion times can obscure the deficits underlying poor performance. Instrumented and wearable technologies extend clinical assessment by quantifying postural sway and gait, helping to distinguish broader mobility gains from recovery within specific balance domains. To translate this distinction into practice, this review recommends individualised, balance-focused CR, with assessment guiding task-specific training and virtual reality or exergaming providing graded practice and performance feedback to promote mobility and independence. Full article

Background/Objective: The EXTRACT registry cohort of 504 patients undergoing transvenous lead extraction (TLE) has been previously reported in terms of periprocedural safety and short-term outcomes. Data on long-term mortality and its predictors in this population remain limited. The study aimed to identify risk factors for overall mortality at three years following TLE. Methods: This is a secondary, long-term follow-up analysis of the previously published EXTRACT registry cohort of 504 consecutive patients who underwent TLE between 2016 and 2022. We conducted a univariate analysis to predict mortality risk following TLE, followed by Cox regression with cross-validation to identify independent predictors of mortality over a 3-year follow-up period; Brier score assessed prediction accuracy for mortality; and decision curve analysis evaluated the clinical usefulness of the model. Results: Mortality data were completed for 487 patients at three-year follow-up. Long-term outcomes of TLE showed that patients with CIED infection (p = 0.0091), higher NYHA class (p < 0.0001), arterial hypertension (p = 0.0068), previous stroke (p = 0.0092), upgraded to condition pacing post-TLE (p = 0.0092), and higher CHA₂DS₂-VA score (p = 0.0026) had markedly higher mortality at three-year follow-up. Increased mortality was independently associated with estimated glomerular filtration rate (eGFR) and the CHA₂DS₂-VA score. Risk increased incrementally with each 1 mL/min/1.73 m² decrease in eGFR (hazard ratio, 0.99; 95% CI, 0.98–0.99), and each 1-point increase in CHA₂DS₂-VA conferred a 12% higher mortality rate (hazard ratio, 1.12; 95% CI, 1.02–1.23). Conclusions: In this prospective registry, 3-year mortality after TLE was driven predominantly by baseline clinical risk rather than procedural factors. Renal dysfunction and a higher CHA₂DS₂-VA score independently predicted death, supporting the incorporation of kidney function and global vascular risk into pre-extraction assessment and post-extraction management. Full article

Background: Exercise-based cardiac rehabilitation (CR) is a cornerstone of secondary cardiovascular prevention and improves functional capacity, quality of life, and clinical outcomes. However, maintaining long-term participation remains a major challenge in routine clinical practice. Adapted Physical Activity (APA) programs represent a community-based strategy to promote continued exercise after outpatient cardiac disease, although evidence regarding long-term retention and functional outcomes in real-world settings remains limited. The aim of this study was to evaluate attrition patterns during a 12-month APA follow-up pathway following cardiac rehabilitation and to explore longitudinal changes in functional outcomes among participants who remained under follow-up. Methods: This retrospective longitudinal observational study included 78 consecutive patients referred to an APA program following outpatient cardiac rehabilitation for myocardial infarction or other cardiovascular conditions. Assessments were performed at baseline (T0), 2 months (T1), 6 months (T2), and 12 months (T3). The primary outcome was attrition, operationally defined as failure to attend scheduled follow-up assessments. Secondary outcomes included walking speed during the 1 km Treadmill Walk Test, lower-limb functional performance, handgrip strength, balance, pain, and self-reported physical activity. Longitudinal changes were analyzed using linear mixed-effects models adjusted for age and sex. Results: Seventy-eight patients were enrolled (48 men, 29 women, one participant with missing sex data; mean age 64 ± 11 years). Follow-up attendance progressively declined from 81% at 2 months to 27% at 6 months and 18% at 12 months. Among participants with available follow-up data, significant improvements were observed in walking speed, lower-limb performance, balance, and motor pain during the early supervised phase of the program, with the most robust changes evident at the 2-month assessment (all p < 0.001). Although favorable values were also observed at later assessments, the marked loss to follow-up substantially limited interpretation of the 6- and 12-month estimates. Handgrip strength showed no significant longitudinal changes, while self-reported physical activity increased at 6 months but remained highly variable across participants. Conclusions: In this real-world APA follow-up pathway after cardiac rehabilitation, substantial attrition was observed, with fewer than one-fifth of participants attending follow-up assessments at 12 months. The most robust secondary finding was the short-term improvement in functional outcomes during the initial supervised phase. Long-term functional estimates should be considered exploratory because of the high attrition rate and potential survivor/selection bias. These findings highlight long-term retention as a key outcome for future community-based exercise programs and support the development of strategies aimed at improving sustained participation after cardiac rehabilitation. Full article

Cardiac rehabilitation (CR) is a multicomponent secondary prevention intervention that improves functional capacity and quality of life across cardiac diagnoses, yet remains markedly underused in heart failure (HF). Existing reviews treat efficacy, coverage, delivery, and equity separately; this narrative review integrates them to clarify why uptake in HF remains low despite an established evidence base. We searched PubMed/MEDLINE and the Cochrane Library from January 2009 through December 2025, prioritizing clinical practice guidelines, landmark trials, systematic reviews, registry analyses, and U.S. policy documents, with narrative synthesis across efficacy, coverage, delivery, and equity. In heart failure with reduced ejection fraction (HFrEF), exercise-based CR consistently improves peak oxygen consumption by roughly 15 to 17 percent, improves health status, and reduces short-term all-cause hospitalization. In heart failure with preserved ejection fraction (HFpEF), supervised exercise improves functional capacity and quality of life, but a large pragmatic outcome trial and Medicare coverage remain lacking. In appropriately selected, clinically stable patients, hybrid and virtual delivery produce comparable short-term functional and quality-of-life gains, with more limited direct evidence for hard clinical endpoints. Closing the HFpEF coverage gap, automating HFrEF referral, diversifying delivery, and embedding equity across the CR pipeline are actionable priorities for realizing CR’s potential in HF. Full article

Introduction: Cardiac rehabilitation (CR) is an evidence-based secondary prevention strategy that improves functional capacity, quality of life, and cardiovascular outcomes. However, adherence to CR programs remains suboptimal, limiting their effectiveness. Methods: A retrospective multicenter cohort study was conducted among patients enrolled in outpatient CR programs at two specialized cardiovascular centers. Adherence was defined as attendance at ≥70% of the prescribed sessions (≥25 of 36 sessions). Bivariate analyses were performed to compare adherent and non-adherent participants. Variables with p < 0.20 were included in a multivariable logistic regression model to identify factors independently associated with adherence. Results: A total of 210 participants were included, of whom 77.6% (163/210) were classified as adherent. The median age was 68 years (IQR 60.3–75.0), and 64.3% were men. Most participants (70.5%) completed more than 30 rehabilitation sessions. Adherence rates were highest among patients undergoing surgical myocardial revascularization (80.6%) and valve surgery (76.0%). In multivariable analysis, program duration was the only factor significantly associated with adherence (OR = 4.59; 95% CI: 2.46–8.59; p < 0.001). History of dyslipidemia showed a non-significant trend toward higher adherence (OR = 3.29; 95% CI: 0.91–11.90; p = 0.069). Educational level, left ventricular ejection fraction, and health insurance affiliation were not independently associated with adherence. Conclusions: Adherence to CR was high in this cohort. Longer participation in the program was the only independent predictor of adherence, highlighting the importance of strategies that promote sustained engagement throughout the rehabilitation process. Full article

Cardiac rehabilitation (CR) is a central component of optimized secondary prevention. Since their inception, CR programmes have progressively evolved. These incorporate several components in a multidisciplinary setting, aimed at addressing the diverse needs of the complex cardiovascular patient. From ischaemic heart disease to heart failure and cardio-oncology, CR has shown its relevance across various moments of the cardiovascular continuum. Notably, data has underscored the importance of an individualized assessment coupled to programme tailoring according to patient characteristics, to harness the full benefits of CR while ensuring safety. Against this background, current guidelines have endorsed CR in different clinical settings. Despite this, several challenges concerning CR implementation remain, including suboptimal referral and compliance rates, as well as underrepresentation of specific patient subgroups. In this article, we provide an overview concerning current paradigms for CR in contemporary clinical practice, while also exploring novel developments and future perspectives on this pivotal field. Full article

Background/Objectives: Cardiovascular toxicity and pre-existing cardiovascular disease can affect cancer-treatment tolerance, functional recovery, and survivorship. This narrative review aimed to summarize current evidence and propose an author-derived risk-adaptive clinical framework for adult cardio-oncology rehabilitation (CORE), organized around exercise prescription, multimodal monitoring, and implementation. Methods: PubMed/MEDLINE and the Web of Science Core Collection were searched from database inception through 27 July 2026. Guidelines, systematic reviews, randomized and non-randomized clinical studies, feasibility studies, and selected mechanistic sources were prioritized according to their relevance to the three review domains. Evidence was classified as direct clinical, guidance/synthesis, feasibility/implementation, or mechanistic/conceptual; no PRISMA protocol, formal risk-of-bias assessment, or meta-analysis was undertaken. Results: Clinical trials support improvements in cardiorespiratory fitness, selected cardiovascular risk factors, and functional outcomes in some settings, but effects on cancer therapy-related cardiac dysfunction, cardiovascular events, and mortality remain uncertain. Direct evidence is dominated by breast-cancer cohorts and women, although mixed-cancer, lymphoma, and lung-cancer studies broaden the functional evidence base. An evidence-informed approach is to individualize aerobic and resistance exercise to treatment context, symptoms, functional capacity, and clinical stability, with reassessment linked to actionable findings; the proposed pathway remains conceptual and non-validated. Artificial intelligence, digital twins, omics, and monitoring-guided exercise-dose adjustment remain investigational. Conclusions: CORE is best regarded as exercise-centered care linked to guideline-based risk assessment and clinically indicated reassessment. Prospective studies should test therapy-specific timing, risk-stratified delivery, monitoring-guided dose adjustment, clinical endpoints, equity, and cost-effectiveness. Full article

Background/Objectives: Ethnic inequities in cardiovascular disease and healthcare access are well recognised worldwide, but it is unclear whether these inequities translate into differences in cardiac rehabilitation participation and subsequent clinical outcomes. This study examined ethnic differences in cardiac rehabilitation enrolment, participation, and mortality outcomes within a large multi-ethnic cohort to determine whether the association between rehabilitation exposure and mortality differed across ethnic groups. Methods: This retrospective cohort study included 4940 consecutive patients referred to the Auckland cardiac rehabilitation programme between 2016 and 2023. Baseline characteristics, rehabilitation participation, and all-cause mortality were examined across ethnic groups. Associations with mortality were assessed using multivariable Cox proportional hazards models adjusted for demographic and clinical risk factors. Results: During a median follow-up of 5.6 years, 565 deaths occurred. Cardiac rehabilitation participation differed across ethnic groups (p < 0.001), with lowest participation among Pacific patients (44.3%) and highest participation among Asian patients (58.6%). Among attenders, total session attendance was similar across ethnic groups (p = 0.35). After adjustment, mortality risk was lower among Asian patients (HR 0.58, 95% CI 0.46–0.74, p < 0.001), but did not differ for Māori (HR 1.21, 95% CI 0.86–1.71) or Pacific patients (HR 1.03, 95% CI 0.79–1.36) compared with Europeans. Greater rehabilitation exposure was associated with lower mortality (HR 0.98 per session, 95% CI 0.97–0.99, p = 0.002), and no interaction between ethnicity and rehabilitation exposure was observed. Conclusions: Ethnic differences in cardiac rehabilitation were evident at the level of enrolment, but not in session exposure among attenders or in the association between rehabilitation participation and mortality. This study highlights the importance of distinguishing inequities in access and engagement from the effectiveness of rehabilitation once delivered. Full article

Background: Device-independent, lifestyle-integrated active pursed-lip diaphragmatic breathing (PLDB) may overcome respiratory rehabilitation barriers in chronic heart failure (CHF). This retrospective real-world study evaluated its prognostic association with functional capacity, quality of life (QoL), and major adverse cardiovascular events (MACE). Methods: A total of 58 CHF patients (NYHA II–IV) were categorized by 6-month post-discharge PLDB adherence into a Respiratory Training Group (RTG; n = 20) and Control Group (n = 38). Functional, structural, QoL metrics, and MACE outcomes were analyzed. Results: After 6 months, the RTG demonstrated significant intra-group improvements in 6 min walk test (6MWT) distance (302.00 [243.60, 408.15] m to 386.00 [339.50, 439.00] m, p = 0.006; baseline-adjusted between-group gain: +76.16 m), handgrip strength (p = 0.046), LVEF (p = 0.003), and scores on the Minnesota Living with Heart Failure Questionnaire (MLHFQ) (p < 0.001), Generalized Anxiety Disorder-7 (GAD-7) (p = 0.010), and Self-rating Somatic Symptom Scale-China (SSS-CN) (p = 0.004). Post-intervention, the RTG outperformed controls in handgrip strength (p = 0.012), MLHFQ (p = 0.001) and SSS-CN (p = 0.020). The RTG exhibited a significantly lower MACE incidence (5.0% vs. 42.1%, p = 0.003) and superior MACE-free survival (log-rank p = 0.005). Multivariable Cox regression confirmed high PLDB adherence was independently associated with a lower MACE risk (adjusted HR = 0.103, 95% CI: 0.014–0.779, p = 0.028). Conclusions: High adherence to a 6-month lifestyle-integrated PLDB program correlates with clinically meaningful improvements in exercise capacity, cardiac function, and QoL, and is independently associated with a lower risk of short-term MACE in CHF patients. Full article

Background/Objectives: To describe therapy-associated oral stomatitis and perianal mucosal lesions in pediatric oncohematology patients and compare healing time according to the treatment approach used in routine clinical practice. Methods: This retrospective observational study was conducted at Meyer Children’s Hospital, Florence, Italy. Electronic health records of patients admitted to the Oncology or Bone Marrow Transplantation units between 1 January and 31 December 2024, were screened. Eligible patients were aged 0 to 18 years and had documented oral stomatitis and/or perianal mucosal lesions with sufficient clinical and nursing documentation to determine lesion localization, treatment, clinical evolution, and healing time. Demographic, clinical, pharmacological, nutritional, and nursing variables were extracted. Oral mucositis severity was classified using the World Health Organization Oral Toxicity Scale. Results: Among 525 screened records, 89 eligible patients aged 5 months to 18 years were included in the final analysis. Lesions were distributed across three mutually exclusive categories: oral-only (39.3%), perianal-only (42.7%), and combined oral–perianal involvement (18.0%). Most oral cases were grade 2 to 4. Oral stomatitis treated with Mucosamin^® Spray healed faster than conventional therapy (3.5 ± 0.8 vs. 6.7 ± 1.1 days; mean difference, −3.21 days; 95% CI, −3.75 to −2.67; p < 0.001). Perianal fissures treated with Mucosamin^® Rectal Gel also showed a shorter healing time than conventional therapy (3.4 ± 0.8 vs. 6.1 ± 0.8 days; mean difference, −2.76 days; 95% CI, −3.30 to −2.21; p < 0.001). Conclusions: Mucosamin^® Spray and Rectal Gel were associated with shorter documented healing times than conventional approaches in this real-world pediatric cohort. These findings should be interpreted as preliminary and confirmed in controlled prospective multicenter studies. Full article

Frailty is common among older adults with type 2 diabetes mellitus (T2DM). However, simple, objective, equipment-free screening tools for early frailty detection are limited. We evaluated the association between the objective one-leg standing test (OLST) and frailty in older male outpatients with T2DM and defined a clinically relevant OLST cut-off for frailty screening. Males aged ≥65 years with T2DM (n = 335) were included in this single-center, retrospective, cross-sectional study. Frailty was pre-categorized based on a Kihon Checklist (KCL) score ≥ 8. The association of OLST time with frailty was assessed by logistic regression. The Youden Index was used to determine the optimal OLST time cut-off. Frailty was observed in 17.3% of the participants. The KCL-frail group exhibited a shorter OLST time than the KCL-non-frail group (median: 12.1 [7.4–30.6] vs. 45.8 [23.2–60.0] s; p < 0.001). Shorter OLST time was independently associated with frailty (odds ratio 0.955 per 1 s increase; 95% confidence interval 0.939–0.971; p < 0.001). The optimal cut-off for identifying frailty was 34.1 s (area under the curve: 0.768). The OLST is an objective, equipment-free physical performance test that may complement subjective frailty screening to identify frailty in an ambulant male population aged ≥65 years with T2DM. Full article

Acute coronary syndrome (ACS) remains a leading cause of cardiovascular morbidity and mortality worldwide. Although traditional cardiovascular risk factors remain central to ACS development, recreational drug use is increasingly recognized as a clinically relevant trigger, particularly in younger patients with fewer conventional risk factors. This narrative review synthesized evidence identified through searches of PubMed/MEDLINE and Scopus up to June 2026, including clinical guidelines, systematic reviews, observational studies, mechanistic investigations, and clinically informative case-based evidence. Cannabis, cocaine, amphetamines, methamphetamine, 3,4-methylenedioxymethamphetamine (MDMA), opioids, lysergic acid diethylamide (LSD), synthetic cannabinoids, and polysubstance use may promote myocardial ischemia and infarction through overlapping mechanisms, including sympathetic activation, coronary vasospasm, endothelial dysfunction, oxidative stress, inflammation, platelet activation, thrombosis, arrhythmogenesis, and myocardial oxygen supply–demand mismatch. Clinical presentation may be typical or atypical and may overlap with intoxication, withdrawal, anxiety, neurological symptoms, or non-cardiac chest pain, making diagnosis challenging. Underreporting of recreational drug use is common, and targeted toxicology screening may improve diagnostic accuracy and risk stratification, particularly in patients younger than 50 years, those with few traditional cardiovascular risk factors, or those presenting with otherwise unexplained ST-segment elevation myocardial infarction (STEMI), non-ST-segment elevation myocardial infarction (NSTEMI), coronary vasospasm, arrhythmias, or cardiac arrest. Acute management should generally follow standard ACS guidelines, while considering drug-specific issues such as stimulant-induced vasospasm, sympathetic excess, cautious use of beta-blockers during acute intoxication, and preference for primary percutaneous coronary intervention when fibrinolysis carries increased risk. Long-term care should combine evidence-based secondary prevention with substance-use counseling, addiction medicine referral, cardiac rehabilitation, and behavioural interventions. This review summarizes the pathophysiology, clinical manifestations, epidemiology, treatment considerations, preventive strategies, and knowledge gaps related to recreational drug-associated ACS. Full article

Walking recovery is a central goal of geriatric rehabilitation, but it is shaped by multiple interacting factors rather than by muscle impairment alone. This mini-review examines whether sarcopenia-related weakness, low muscle quality, and reduced physical reserve identify a clinically important vulnerability phenotype relevant to delayed gait recovery in older adults after hospitalization, hip fracture, surgery, or cardiac procedures. We summarize current consensus definitions of sarcopenia, explain why muscle strength and physical performance are often more clinically informative than muscle mass alone, and review the mechanistic pathways that may connect sarcopenia with impaired walking, including anabolic resistance, inflammation, disuse, neuromuscular remodeling, trunk weakness, and cognitive–emotional modifiers. Across community, orthogeriatric, post-acute, and cardiac rehabilitation settings, sarcopenia markers are generally associated with slower gait or poorer attained mobility; however, findings for change in mobility are inconsistent, and most available studies are observational, heterogeneous, or indirect. Sarcopenia should therefore be interpreted as one potential marker of reduced reserve and mobility risk rather than as a determinant of walking recovery or evidence that sarcopenia-aware rehabilitation improves outcomes. Future work should use more consistent diagnostic frameworks and test whether a sarcopenia-aware rehabilitation integrating early strength assessment, individualized nutrition care, and multicomponent gait rehabilitation improve walking outcomes in medically complex older adults beyond current standards of care. Full article

Background/Objectives: Pediatric mild-to-moderate burns require careful management in the early phase, yet evidence guiding optimal initial dressing selection remains limited. Although topical medications and specialized dressings are routinely used, a universally accepted standard of care is lacking. Methods: We conducted a 1-year, real-world, retrospective, comparative, single-center study evaluating whether treatment with enzyme alginogel (Flaminal^®) or NaOCl 0.05% antiseptic in the first 24 h led to different outcomes in terms of healing time, lesion progression, complication occurrence, scar quality, and burden of care. Medical records of 80 children with mild-to-moderate burns (Total Body Surface Area < 15%) treated between January and December 2024 were analyzed. Results: Despite a higher proportion of deep burns, early treatment with enzyme alginogel was associated with a 6.17-day [95% Confidence Interval: 4.71–7.63 days] shorter healing time (p < 0.001), with no observed lesion worsening or need for early surgery. The complication rate was 14% in the enzyme alginogel group, while all patients receiving antiseptic dressing had at least one complication (p < 0.001). Patients treated with enzyme alginogel also showed better Vancouver Scar Score [2.95 points, 95% Confidence Interval: 2.33–3.23, p < 0.001] and fewer follow-up visits, supporting a direct relationship between healing time and scar outcomes, and suggesting a potential reduction in the burden of care. Conclusions: Early management with alginogel favored healing, reduced complications, improved scar outcomes, and reduced burden of care in comparison to the initial treatment with NaOCl-based antiseptic dressings followed by treatment change when clinically indicated. Prospective, comparative, randomized studies are needed to confirm these findings. Full article