Category: Cardiovascular

The European Society of Cardiology (ESC) will highlight 30 late-breaking studies during Hot Line sessions at its annual meeting Aug. 25-28, 2023, in Amsterdam. The complete list of sessions and studies being presented is below. John McMurray, ESC Congress program committee chair, believes there are several key sessions attendees should be looking forward to as the show approaches. In the Hot Line 1 session, the STEP HFpEF trial will examine the effects of once-weekly semaglutide in people with heart failure with preserved ejection fraction (HFpEF) and obesity. “This is a treatment targeting a common and increasing comorbidity in this type of heart failure. Obesity is associated with much worse symptoms and functional capacity and a higher risk of hospitalization. We hope reducing obesity will help patients with HFpEF,” McMurray said in a statement. The NOAH-AFNET 6 trial, meanwhile, examines oral anticoagulation in patients with atrial high-rate episodes. “This trial attempts to answer the very important clinical question of whether we should use anticoagulant therapy in patients with brief episodes of atrial fibrillation (AFib). We know that sustained AFib leads to a high risk of stroke, which can be effectively and safely (with respect to bleeding) reduced by treatment with an anticoagulant – but is this also true for short episodes of AFib?” The first Hot Line session concludes with COP-AF. “AFib and myocardial injury are common complications of thoracic surgery and are associated with high risks of death, stroke and longer hospital stays. Inflammation may play a role in causing these complications and colchicine has anti-inflammatory activity recently shown to be of benefit in patients with coronary artery disease. This large trial has tested whether starting colchicine pre-operatively reduces the risk of these complications,” McMurray explained. He also emphasized HEART-FID, which will be presented in Hot Line 2. “Iron deficiency is very common in patients with heart failure and reduced ejection fraction (HFrEF) and intravenous iron seems to improve symptoms and exercise tolerance,” McMurray said. “However, the AFFIRM-HF and IRONMAN trials have left some uncertainty about the effects of this therapy on hospitalization and mortality. HEART-FID is by far the largest trial to date using this treatment.” Hot Line 4 could be one of the highlights of the entire conference for many cardiologists, McMurray said. It includes a series of trials – ILUMIEN IV, OCTIVUS and OCTOBER, which compare optical coherence tomography (OCT)-guided, intravascular ultrasound (IVUS)-guided and angiography-guided percutaneous coronary intervention (PCI). “The session also will have a real-time updated network meta-analysis presented, hopefully again providing the definitive evidence to guide the optimal approach to PCI,” he said. Hot Line Session 1 Aug. 25, 11:15 a.m. • STEP HFpEF: once-weekly semaglutide in people with HFpEF and obesity. Speaker: Mikhail Kosiborod, St. Luke’s Mid America Heart Institute – Kansas City, United States. • NOAH-AFNET 6: Oral anticoagulation in patients with atrial high rate episodes. Speaker: Paulus Kirchhof (University Heart and Vascular Center Hamburg, Germany. • COP-AF – Colchicine for the prevention of perioperative atrial fibrillation after major thoracic surgery. Speaker: David Conen, Population Health Research Institute, Hamilton, Canada. Hot Line Session 2 Aug. 26, 8:30 a.m. • Qiliqiangxin in patients with heart failure and reduced ejection fraction – the QUEST study. Speaker: Xinli Li, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China. • BUDAPEST CRT Upgrade: Cardiac resynchronisation therapy upgrade in heart failure with right ventricular pacing – a multicentre, randomised, controlled trial. Speaker: Bela Merkely, Semmelweis University Heart and Vascular Center, Budapest, Hungary. • HEART-FID: Ferric Carboxymaltose in Heart Failure with Iron Deficiency. Speaker: Robert Mentz, Duke University Medical Center – Durham, United States. • Effects of FCM on recurrent HF hospitalizations: an individual participant data meta-analysis. Speaker: Piotr Ponikowski, Wroclaw Medical University, Wroclaw, Poland. Hot Line Session 3 Aug. 26, 4:30 p.m. • FIRE trial: Physiology-Guided Complete PCI in Older MI Patients. Speaker: Simone Biscaglia, University Hospital Santa Anna, Ferrara, Italy. • ECLS-SHOCK – venoarterial membrane oxygenation in cardiogenic shock. Speaker: Holger Thiele, Heart Center Leipzig at University of Leipzig, Germany. • STOPDAPT-3: An Aspirin-Free antithrombotic strategy for percutaneous coronary intervention. Speaker: Masahiro Natsuaki, Saga University, Saga, Japan. Hot Line Session 4 Aug. 27, 8:30 a.m. • ILUMIEN IV: OCT Versus Angiography. Speaker: Ziad Ali, DeMatteis – St Francis, United States • OCT-guided or angiography-guided PCI in complex bifurcation lesions. The OCTOBER trial. Speaker: Lene Nyhus Andreasen, Aarhus University Hospital, Aarhus, Denmark. • OCTIVUS: OCT- vs. IVUS-Guided PCI. Speaker: Duk-Woo Park, Asan Medical Center, Seoul, South Korea • OCT vs. IVUS vs. angiography guidance: a real-time updated network meta-analysis. Speaker: Gregg Stone, Icahn School of Medicine at Mount Sinai, New York, United States. Hot Line Session 5 Aug. 27, 11:15 a.m. • ATTRibute-CM: acoramidis (AG10) in patients with transthyretin amyloid cardiomyopathy. Speaker: Julian Gillmore, Royal Free London NHS Foundation Trust. • ARREST trial: Expedited transfer to a cardiac arrest center for OHCA. Speaker: Tiffany Patterson, Guy’s and St. Thomas’ NHS Trust Hospitals, London. • ADVENT: Pulsed Field Ablation vs. Thermal Ablation (RF/Cryo) for Paroxysmal AF. Vivek Reddy, Icahn School of Medicine at Mount Sinai, New York, United States.

<!– –> GlobalData tracks drug-specific phase transition and likelihood of approval scores, in addition to indication benchmarks based off 18 years of historical drug development data. Attributes of the drug, company and its clinical trials play a fundamental role in drug-specific PTSR and likelihood of approval. BR-6002 overview BR-6002 is under development for the treatment of cardiovascular disease, gastric ulcers and duodenal ulcers. It is administered through oral route. Boryung Pharmaceutical overview Boryung Pharmaceutical (Boryung)is a pharmaceutical company. It manufactures and distributes pharmaceutical products including cardiovascular, anticancer and gastrointestinal drugs. The company offers products such as kanarb, kanab plus, dukarb, dukaro, akarb, VCS inj, velkin injection, alimxid injection, effcil injection, oxalitin, neoplatin, EP mycin and AD mycin. Boryung gastrointestinal includes gelfosM for the treatment of hypogastric acidity, heartburn, gastric and duodenal ulcer, gastritis, gastralgia and nausea. The company also provides marketed API. Boryung is headquartered in Seoul, South Korea. For a complete picture of BR-6002’s drug-specific PTSR and LoA scores, buy the report here. This content was updated on 1 January 1970 Sign up for our daily news round-up! Give your business an edge with our leading industry insights. GlobalData, the leading provider of industry intelligence, provided the underlying data, research, and analysis used to produce this article. GlobalData’s Likelihood of Approval analytics tool dynamically assesses and predicts how likely a drug will move to the next stage in clinical development (PTSR), as well as how likely the drug will be approved (LoA). This is based on a combination of machine learning and a proprietary algorithm to process data points from various databases found on GlobalData’s Pharmaceutical Intelligence Center. Share this article

Sign up for our free Health Check email to receive exclusive analysis on the week in health Get our free Health Check email Foods in the typical British diet may increase the risk of deadly cardiovascular diseases, two new studies have found. In twin presentations to the annual meeting of the European Society of Cardiology in Amsterdam, researchers revealed the consumption of ult,ra-processed food (UPF) such as cereals, fizzy drinks and fast food, significantly raises the risk of high blood pressure, heart disease, heart attacks and strokes. Food campaigner Henry Dimbleby said the results should serve as a “wake-up call” for the UK. Britain is particularly bad for ultra-processed food. It is storing up problems for the future. If we do nothing, a tidal wave of harm is going to hit the NHS Henry Dimbleby He told The Guardian: “Given that UPF represents 55% of our diet, that should be a wake-up call. “If there is something inherent in the processing of foods that is harmful, then that is a disaster. “Britain is particularly bad for ultra-processed food. It is storing up problems for the future. If we do nothing, a tidal wave of harm is going to hit the NHS.” The Guardian reports Anushriya Pant, a researcher involved with one of the studies, told reporters in Amsterdam that many people are unaware of what foods may be putting them in danger. She said: “It could be that foods you think are healthy are actually contributing to you developing high blood pressure.” She added that many people assumed some UPF, such as store-bought sandwiches, wraps, soups and low-fat yoghurts, were healthier choices when compared to junk food. Ms Pant and her fellow researchers from the University of Sydney studied the impact of the increased consumption of UPF on more than 10,000 middle-aged women during the last 15 years. They found that 39% of women were more likely to develop high blood pressure when compared with those with the lowest intake of ultra-processed food. The second study, presented by Yang Qu on behalf of the researchers at China’s Fourth Military Medical University, found those who ate the most UPF were nearly 25% more likely to suffer from a heart attack, stroke, or angina. Additionally, researchers found increasing the intake of UPF by a mere 10% saw the risk of heart disease jump significantly. The team also discoveredthose who had less than 15% of their diet made up of UPF were the least at risk of suffering from heart-related medical problems.

Ultra-processed food significantly raises the risk of high blood pressure, heart disease, heart attacks and strokes, according to two studies presented this weekend at the European Society of Cardiology Congress in Amsterdam. The first study, which tracked 10,000 Australian women for 15 years, found that those with the highest proportion of ultra-processed food (UPF) in their diet were 39 per cent more likely to develop high blood pressure than those with the lowest. The second study, a wide-ranging analysis of 10 studies involving more than 325,000 men and women, showed those who ate the most UPF were 24 per cent more likely to have serious heart and circulatory events including heart attacks, strokes and angina. Processing is the problem More than half of the typical British daily diet is made up of ultra-processed food, more than any other country in Europe. The products, made using a series of industrial processes, are often high in salt and sugar and may contain additives and preservatives. They include breakfast cereals, ready meals, frozen pizzas, sweets and biscuits. In the first study, the link between UPF consumption and a greater risk of high blood pressure remained even after researchers had adjusted their analysis to account for the impact of salt, sugar, fat and other nutrients. This suggests that it is the processing itself that is harmful. High blood pressure, or hypertension, increases the risk of serious heart and circulatory conditions including heart disease, peripheral arterial disease, and vascular dementia. According to the larger study, a 10 per cent increase in UPF consumption in daily calorie intake was associated with a 6% increased risk of heart disease. Those with UPF making up less than 15 per cent of their diet were least at risk of any heart problems. “Increasing concern” Dr Sonya Babu-Narayan, our Associate Medical Director, said: “There is increasing concern about links shown between ultra-processed foods and cardiovascular disease. The study of women in Australia showed an association between higher consumption of these foods and the development of high blood pressure. “More research is needed to better understand why these links have been found and what the mechanisms are. For example, we don’t know to what degree this is driven by artificial additives or the high levels of salt, sugar and fat that these foods tend to contain. “We do know that the world around us doesn’t always make it easy for the healthy option to be the accessible and affordable option. On the contrary, less healthy foods often take centre stage. To address this we need a comprehensive strategy that creates an environment that can support people to live long and healthy lives.” Find out more about our healthy eating advice

Bayhealth recently held an informational event for residents of The Peninsula in Millsboro. Ben Collins, senior director of operations for the cardiovascular service line, spoke about how patients with cardiovascular conditions can expect the highest quality of care at Bayhealth. This was one of several such events the Bayhealth Foundation has hosted throughout central and southern Delaware to inform residents that they don’t have to travel far to take care of their health needs. Bayhealth’s Cardiovascular Service Line recently earned the HeartCARE Center National Distinction of Excellence, which recognizes demonstrated commitment to comprehensive, high-quality culture and cardiovascular care. Bayhealth has also received cardiac cath lab accreditation and electrophysiology lab accreditation, and was first in the state to receive transcatheter aortic valve replacement certification. “It’s important for patients to know that they can get the high-quality care they deserve right here in Delaware,” said Lindsay Rhodenbaugh, DMin, Bayhealth Foundation president. For more information, go to Bayhealth.org/Foundation.

Risk for recurrent cardiovascular (CV) events among patients with a recent acute coronary syndrome (ACS) hospitalization may be reduced with early intensification of lipid-lowering therapy posthospitalization, according to a study presented at the National Lipid Association (NLA) Scientific Sessions 2023, held in Atlanta, Georgia, between June 1 and June 4, 2023. The ongoing VICTORION-INCEPTION trial (ClinicalTrials.gov Identifier: NCT04873934) is planned to be completed in 2024. It is a phase 3b, randomized, parallel-group, open-label study that includes 384 patients aged at least 18 years from more than 60 locations across the United States. Researchers aim to examine the effect of inclisiran added to usual care vs usual care alone on low-density lipoprotein cholesterol (LDL-C) concentrations among patients recently hospitalized for ACS who have LDL-C concentrations equal to at least 70 mg/dL despite statin therapy. Percentage change from baseline to Day 330 in LDL-C concentration and proportion of patients at Day 330 achieving LDL-C of less than 70 mg/dL are the primary endpoints. Continue Reading Secondary outcomes of the study will be changes in intensity of lipid-lowering therapy from baseline to Day 330, the proportion of patients discontinuing statins at Day 330, the proportion of patients achieving prespecified LDL-C targets after Day 90 and Day 330, and absolute changes from baseline to Day 330 in LDL-C. Inclusion criteria include ACS within 5 weeks (inpatient/outpatient) of enrollment and LDL-C concentration of at least 70 mg/dL or non-high-density lipoprotein cholesterol of at least 100 mg/dL despite statin therapy. Additionally, patients will have fasting triglyceride concentrations of less than 4.52 mmol/L at screening and estimated glomerular filtration rate of greater than 20 mL/min. Patients will be randomly assigned in a 1:1 ratio to inclisiran plus usual care (n=192) or usual care alone (n=192). Inclisiran therapy will be inclisiran sodium 300 mg subcutaneously twice yearly after initial doses at baseline and 3 months. The researchers plan to discontinue inclisiran in patients with unexplained creatinine kinase values, changes in liver parameters meeting study drug interruption criteria, or with intolerable adverse events. Statin therapy and usual care will continue among patients in both groups. The researchers noted that usual care may include anti-PCSK9 monoclonal antibodies in the usual care group only, or inclisiran in the usual care group if the treating physician prescribes it (acquired through commercial outlet). The discretion of the treating physician will be used for adjustments in therapy during the study other than for inclisiran in the inclisiran arm. LDL-C values obtained as part of the study will not be accessible by treating physicians, however at their discretion, physicians can perform these assessments. Study limitations include patients in the usual care only arm receiving inclisiran by treating physicians. Disclosure: This research is supported by Novartis Pharmaceuticals Corporation. Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures. Reference Anderson JL, Navar AM, Balachander N, LeCocq J, Desai NR, Knowlton KU. A randomized study to compare LDL-C lowering effects of inclisiran with usual care vs usual care alone in patients with recent hospitalization for an acute coronary syndrome: rationale and design of the VICTORION-INCEPTION trial. Abstract presented at: National Lipid Association (NLA) Scientific Sessions 2023; June 1-4, 2023; Atlanta, GA. Abstract #130. Topics: Cardiovascular Disease Medications

Ultra-processed foods (UPF) may increase the risk of high blood pressure, heart disease, heart attacks and strokes, two new studies have found. One of the presentations to the European Society of Cardiology in Amsterdam suggests consuming things like breakfast cereals, fizzy drinks and fast food could increase the risk of cardiovascular disease by almost 25%. Ultra-processed foods are generally defined as those that typically have five or more ingredients and include additives and ingredients that are not generally used in home cooking. What do the studies say? A team of researchers from the University of Sydney studied how increased consumption of UPF affected more than 10,000 middle-aged women over the last 15 years. They found that those with the highest proportion of UPF in their diet were 39% more likely to develop high blood pressure than those with the lowest, The Guardian reported. The second study, by researchers at China’s Fourth Military Medical University, found those who ate the most UPF were almost 25% more likely to suffer from a heart attack, stroke, or angina. More on Food Related Topics: Increasing the intake of UPF by only 10% caused the risk of heart disease to jump significantly, they added. Those with less than 15% of UPF in their diet were least likely to suffer from heart-related medical problems. Advertisement While researchers said there was a “non-linear relationship between UPF consumption and cardiovascular events”, they added: “Heavy UPF consumption was significantly and positively associated with increased risk of cardiovascular events.” Image: Mass manufactured bread can count as ultra-processed What are UPFs? It is estimated that more than half of British diets are made up of ultra-processed food – items which have gone through a series of industrial processes, and may contain preservatives. According to the British Heart Foundation, they often contain high levels of saturated fat, salt and sugar. That means there is “less room in our diets for more nutritious foods”, the BHF says. Ultra-processed foods include: Fizzy drinks, chocolate and sweets, hot dogs, sausages, hamburgers, meatballs, instant soup and noodles, ready meals, margarine and spreads, meal substitute shakes and breakfast cereals. Some seemingly ‘natural’ UPFs Most of the bread or buns in a supermarket bread aisle, cereal bars, fruit yogurts and ready-to-heat products. Like pre-prepared pies and pizzas, they may all seem pretty harmless when you view them on the supermarket shelf, but they actually qualify as ultra-processed. That is because they may contain extra ingredients added during production, such as emulsifiers, sweeteners, and artificial colours and flavours. Processed foods: Tends to be products with a few extra ingredients – typically made by adding things like sugar, oil and salt to unprocessed food. They include: canned fruit and vegetables, salted or sugared nuts and seeds, salted, cured or smoked meats, canned fish, fruit in syrup, cheese and handmade bread. Unprocessed or minimally processed foods: Fruit, vegetables, pulses, rice, seeds, pasta, eggs, fresh meat, fish and milk. How to eat healthily The best way to get your nutrition is via fresh, unprocessed food, cooked from scratch. A Mediterranean diet is often cited as healthy. It is recommended by the British Heart Foundation because it contains plenty of “minimally or unprocessed foods such as fruit, vegetables, fish, nuts and seeds, beans, lentils and wholegrains”, said dietitian Victoria Taylor. Read more on Sky News:Ultra-processed food linked to early death, studies findDo you know how much salt you should be eating?Bringing cake to office ‘as harmful as passive smoking’ Image: Some breakfast cereals are classed as ultra-processed What do experts say? Former government food adviser Henry Dimbleby said the results should be a “wake-up call” for the UK. “If there is something inherent in the processing of foods that is harmful, then that is a disaster,” he told The Guardian. “Britain is particularly bad for ultra-processed food. It is storing up problems for the future. If we do nothing, a tidal wave of harm is going to hit the NHS.” Dr Chris van Tulleken, a TV doctor who has written a book on UPF called Ultra Processed People, said the studies were “entirely consistent with a large and growing body of work showing that increasing consumption of UPF is associated with an increased risk of cardiovascular disease”. He added: “Almost every food that comes with a health claim on the packet is UPF. “There is now significant evidence that these products inflame the gut, disrupt appetite regulation, alter hormone levels and cause myriad other effects which likely increase the risk of cardiovascular and other disease much in the same way that smoking does.”

Abstract Associations between delirium and postoperative adverse events in cardiovascular surgery have been reported and the preoperative identification of high-risk patients of delirium is needed to implement focused interventions. We aimed to develop and validate machine learning models to predict post-cardiovascular surgery delirium. Patients aged ≥ 40 years who underwent cardiovascular surgery at a single hospital were prospectively enrolled. Preoperative and intraoperative factors were assessed. Each patient was evaluated for postoperative delirium 7 days after surgery. We developed machine learning models using the Bernoulli naive Bayes, Support vector machine, Random forest, Extra-trees, and XGBoost algorithms. Stratified fivefold cross-validation was performed for each developed model. Of the 87 patients, 24 (27.6%) developed postoperative delirium. Age, use of psychotropic drugs, cognitive function (Mini-Cog < 4), index of activities of daily living (Barthel Index < 100), history of stroke or cerebral hemorrhage, and eGFR (estimated glomerular filtration rate) < 60 were selected to develop delirium prediction models. The Extra-trees model had the best area under the receiver operating characteristic curve (0.76 [standard deviation 0.11]; sensitivity: 0.63; specificity: 0.78). XGBoost showed the highest sensitivity (AUROC, 0.75 [0.07]; sensitivity: 0.67; specificity: 0.79). Machine learning algorithms could predict post-cardiovascular delirium using preoperative data. Trial registration: UMIN-CTR (ID; UMIN000049390). Introduction Delirium is a variable acute-onset disturbance of attention and consciousness that has multiple etiologies1. Surgery is a common risk factor for delirium, with postoperative delirium occurring in 14–24% of patients following non-cardiac surgery2,3. Furthermore, approximately 26–56% of cardiovascular surgery patients who require the use of cardiopulmonary bypass (CPB) develop postoperative delirium4,5,6,7. Delirium following cardiovascular surgery is independently associated with a decline in cognitive function8, activities of daily living (ADL)6,9,10 and increased mortality11. Thus, postoperative delirium is an important factor that influences patient prognosis. The American Heart Association issued a statement in 2020 to integrate measures against delirium into Cardiovascular Intensive Care Unit (ICU) care12. Recently, the European Society of Anesthesiology (2017)13 and POQI-6 (2019)14 have introduced guidelines for postoperative prevention and recommended multicomponent non-pharmacological interventions for delirium. The Hospital Elder Life Program (HELP)15, the most well-known non-pharmacological multidisciplinary program, reduces delirium by 53%16. However, it is difficult to apply these measures to all patients14. In a cross-sectional study of acute hospitals implementing HELP, the most common reasons for non-compliance with the original HELP program were lack of adequate staffing and budgetary limitation17. As pharmacological therapy, ramelteon and suvorexant also reportedly reduce delirium18,19, but premedication to prevent delirium is not recommended for use in all patients20. Therefore, early prediction and identification of individuals at high risk for delirium are needed to provide targeted and efficient interventions14,21. Several studies have aimed to predict postoperative delirium. However, the accuracy of prediction models for patients in the ICU is insufficient when applied to those undergoing cardiovascular surgery22, and delirium prediction models should be constructed only for a specific group of patients23. Conventional prediction models based on statistical methods for patients undergoing cardiovascular surgery include those by Koster24 and Rudolph4; both reported an area under the receiver operating characteristic curve (AUROC) of 0.75. Although statistical models such as logistic regression are favorable in terms of model interpretability, machine learning is preferred for prediction models25. Clinical prediction models using machine learning algorithms have recently attracted attention. In the area of cardiovascular surgery-associated postoperative delirium, both Mufti26 and Xue27 showed that the prediction performance of machine learning algorithms was superior to that of conventional statistical models, limited to hyperactive delirium and acute kidney injury-related delirium, respectively. Delirium is classified into three subtypes based on the type of psychomotor activity: hyperactive, hypoactive, and mixed1. Hypoactive delirium reportedly accounts for 92% of all cases of delirium in the cardiovascular ICU28. Therefore, we must assess and deal with delirium, including the hypoactive subtype which is often overlooked in clinical practice. We aimed to develop and validate new prediction models for cardiovascular surgery-associated postoperative delirium including hypoactive subtype using machine learning algorithms. Early identification of patients at high risk of delirium is critical to effectively implement prevention strategies, such as multicomponent interventions and prophylactic medications. Methods Setting and study population This single-center prospective study included patients aged ≥ 40 years who underwent cardiovascular surgery at Osaka University Hospital between November 2021 and October 2022. The inclusion criteria were patients who underwent coronary artery bypass graft (CABG), valve surgery, ascending aortic replacement (AAR) via a median sternotomy, or minimally invasive cardiac surgery (MICS) using cardiopulmonary bypass (CPB). The exclusion criteria were as follows: (1) patients undergoing transcatheter aortic valve implantation (TAVI) or thoracic endovascular aortic repair (TEVAR); (2) patients managed with deep hypothermic circulatory arrest or selective cerebral perfusion; (3) patients with preoperative delirium; (4) patients diagnosed and treated for dementia preoperatively; (5) patients requiring mechanical ventilation for > 3 days postoperatively, (6) patients with cerebral hemorrhage or stroke within 7 days after surgery; (7) patients requiring reoperation within 7 days after surgery; and 8) patients with suspected alcohol withdrawal delirium. The criteria for alcohol withdrawal delirium were consumption of an average of 60 g or more of alcohol per day immediately prior to admission and the development of delirium within 2 weeks of admission. Ethics declarations and consent to participate This study was approved by the Ethical Review Committee of Osaka University Hospital (No: 21158-3; 2021/09/11) and followed the Declaration of Helsinki. All patients provided written informed consent. Variable selection The electronic medical records of all patients were prospectively reviewed. We collected 38 preoperative factors, including demographics, medical history, laboratory data, and life history, as well as 10 intraoperative factors, including operation time, pump time, and blood fluid balance. The entire list of 48 variables can be found as Supplementary Table S1 and S2 online. A trained nurse visited the patients on any one day from admission to surgery and assessed their function using the Mini-Cog29 Japanese version, Geriatric Depression Scale-Short Version-Japanese (GDS-S-J)30, and Barthel Index31. Delirium assessment All patients were followed for 7 days, with day 0 being the day of surgery. Electronic medical records were reviewed daily. The evaluation of delirium began when the patient was extubated in the ICU. A psychiatrist (MH) or a critical nurse

CARDIOVASCULAR FITNESS IS, quite simply, the cornerstone of complete health and wellbeing. It’s the engine that powers your body, ensuring that your heart and lungs function optimally, powering your workouts. Understanding and prioritising your level of cardiovascular fitness is just as important as taking care of other forms of conditioning. You wouldn’t attempt a bench press personal best with an aching shoulder, so why would you do it if your cardiovascular fitness isn’t up to scratch? Cardiovascular fitness might not be the first area that comes to mind when preparing for a particularly taxing workout, but it should be. The impact of improving cardiovascular fitness can be extensive and far-reaching. If this is the first time the importance of cardiovascular fitness has occurred to you, don’t worry. We’ll help you understand it and provide a variety of practical tips to boost it. What is cardiovascular fitness? Cardiovascular fitness, occasionally called aerobic fitness or more simply, cardio, refers to the ability of your cardiovascular system to efficiently transport oxygen and nutrients to your muscles and organs while removing waste products. It can be measured by tracking your heart rate during exercise. Someone with good cardiovascular fitness will be able to keep their heart rate low and steady during periods of strenuous exercise, and subsequently be able to exercise for longer. It’s as good a test of your overall fitness as there ever was. To understand cardiovascular fitness in practice, consider that while a bulked-up powerlifter with an outsized physique may be able to lift heavy, they could struggle in comparison to a guy who goes on a tri-weekly run if it came to a test of cardiovascular fitness. Such tests prioritise endurance and stamina over short bursts of energy—and big muscles. Hence why a veritable gym junkie who pumps iron almost everyday might not be as fit as someone who pounds the pavement with consistency. While cardiovascular fitness is a good indicator of overall health, it isn’t the only indicator. Overall health ultimately depends on the relationship between your cardiovascular, respiratory, muscular and skeletal systems. Why is cardiovascular fitness important? Cardiovascular fitness is important in the same way that fitness in general is important. As even the most remotely health-conscious person will know, strong personal fitness is necessary if you want to live a long and healthy life—and cardiovascular fitness plays a pivotal part in that. The impact of improving cardiovascular fitness can be felt across many different areas of health. Let’s break them down. Heart Health: Cardiovascular fitness strengthens your heart, making it more efficient at pumping blood and reducing the risk of heart diseases, such as coronary artery disease and high blood pressure. Lung Function: Regular cardiovascular exercise improves lung capacity and oxygen exchange, which can prevent respiratory issues and increase your stamina. Weight Management: An obvious benefit here. Engaging in exercise that improves cardiovascular fitness can help you burn calories, aiding in weight management and reducing the risk of obesity. Mood Enhancement: Cardiovascular workouts trigger the release of endorphins, which can help alleviate stress, anxiety, and depression, improving your overall mental health. Energy Levels: Improved cardiovascular fitness means your body can efficiently utilise oxygen, giving you more energy to carry out daily activities. Quality of Life: In case you weren’t already convinced of its supreme importance, strong cardiovascular fitness is even linked to a higher quality of life and increased longevity. How can you improve your cardiovascular fitness? Now that we understand the importance of cardiovascular fitness, let’s dive into how you can improve it. Here’s our comprehensive guide to improving cardiovascular fitness. Start slowly: If you’re entirely unfamiliar with cardio exercise and don’t know how to get started, begin with low-impact activities like walking, swimming, or cycling. Gradually increase the intensity and duration of your workouts. The same goes for those already experienced in cardio workouts. The journey to improved cardiovascular fitness doesn’t begin with a sudden jolt into far more intense exercise, but with a steady rise. Set realistic goals: It’s important not to set your sights too high, at least at the start. Establish clear fitness goals and create a plan that includes both short-term and long-term objectives. Mix it up: Variety is key to maintaining motivation and challenging your body. Include a mix of activities to keep things interesting, or you could risk boredom becoming your biggest barrier to success. Consistency is key: Aim for at least 150 minutes of moderate-intensity exercise or 75 minutes of high-intensity exercise per week, as recommended by the World Health Organisation. Going all out in a single, sweat-swamping session each week isn’t going to yield beneficial long-term results. Monitor your heart rate: Invest in a heart rate monitor to ensure you’re working out in the right heart rate zone. This helps you maximise the benefits of your workouts and avoid overexertion. Strength training: Incorporate strength training into your routine to complement your cardiovascular workouts. Strong muscles can improve overall endurance and performance. And no, cardio won’t kill your gains. Listen to your body: Pay attention to your body’s signals. Rest when needed, stay hydrated, and fuel your body with a balanced diet to support your cardiovascular fitness journey. Get professional guidance: If you’re unsure of where to start, or aren’t getting the desired results, consider consulting with a fitness trainer or healthcare professional for a personalised plan. What are good cardiovascular exercises? Technically, anything that gets your heart rate up can be counted as cardiovascular exercise, but some methods are far more effective than others. Outside of the gym, running is an effective, easy to do exercise that is almost guaranteed to deliver improved cardiovascular fitness. Swimming will do the same, with the added benefit of a lower impact on your ailing body. Walking and cycling can also produce positive results. In the gym, it’s all about the equipment. Spending time on a treadmill, elliptical machine, stair climber, rowing machine, or an exercise bike will no doubt work some magic. At home, further simple steps can be

WEDNESDAY, Nov. 29, 2023 (HealthDay News) — Although community-level distress is associated with lower cardiac rehabilitation (CR) participation, the clinical benefits are universal across all communities, according to a study published in the November issue of Circulation: Cardiovascular Quality and Outcomes. Michael P. Thompson, Ph.D., from Michigan Medicine in Ann Arbor, and colleagues evaluated the relationship between community-level distress and CR participation, access to CR facilities, and clinical outcomes. The analysis included 414,730 Medicare beneficiaries undergoing inpatient coronary revascularization between July 2016 and December 2018. The researchers found that any CR use was lower for beneficiaries in distressed versus prosperous communities (26.0 versus 46.1 percent), which remained significant after multivariable adjustment (odds ratio, 0.41). One-quarter of beneficiaries (23.7 percent) had a CR facility within their ZIP code, which increased from 16.3 percent in prosperous communities to 26.6 percent in distressed communities. There was an association observed between any CR use and absolute reductions in mortality (−6.8 percent), all-cause hospitalization (−5.9 percent), and acute myocardial infarction hospitalization (−1.3 percent), which were similar across Distressed Community Index quintiles. “Addressing barriers to participation in cardiac rehabilitation in distressed communities may improve outcomes for these patients and reduce longstanding disparities in such outcomes,” Thompson said in a statement. One author disclosed ties to Medtronic, Abbott, FineHeart, and CH Biomedical. Abstract/Full Text (subscription or payment may be required)