CESAR member Johan Israelsson has participated in a large international study with the title “Variability in functional outcome and treatment practices by treatment center after out‑of‑hospital cardiac arrest: analysis of International Cardiac Arrest Registry” recently published in Intensive Care Medicine, https://doi.org/10.1007/s00134-019-05580-7

The study analysed data from the International Cardiac Arrest Registry (INTCAR), with the aim to examine variation in functional outcome and in-hospital management with regard to center, for patients suffering out-of-hospital cardiac arrest (CA). The INTCAR is an international (centers from Europe and the US) database including patients admitted to an intensive care unit after suffering CA. In the present study a total of 3855 patients were included. There were major variability (from 11% to 63%) in good outcome between centers, also after adjusting for patient-related factors. High performing centers were characterized by 1) having shorter time to goal temperature when initiating target temperature management (TTM), 2) more often using 33°C as goal temperature for TTM, 3) being more likely to perform percutaneous coronary intervention in unconscious patients and 4) using a variation of methods for prognostication, when compared to low performing centers. The authors conclude that center-specific differences in functional outcome exist. These differences are partially explained by differences in treatment.

This week Anna Strömberg, Tiny Jaarsma and Ekaterini Lambrinou held a great webinar arranged by ACNAP.

The learning objectives were;

• Develop and/or test clinical skills on heart Failure clinical cases
• Develop and /or test knowledge and clinical skills in assessing, diagnosing and managing cases in heart failure
• Present two clinical cases on acute decompensated heart failure and on the management of chronic heart failure
• Learn useful and evidence-based practical information on the care of heart failure patients from an acute event to the management of chronic heart failure
• Learn how to develop evidence-based algorithms or pathways for the care of patients with heart failure

The AHA congress that was compressed to three scientific sessions days were held in the windy city of Chicago. AHA is a great congress where everyone interested in cardiovascular research can find once home. McCormick place is one of the largest convention center in north US and a time schedule was a good way to keep on track of the 4000 abstracts and 800 sessions that was presented from more than 100 countries!

Many interesting presentations include mindfulness and yoga for patients with atrial fibrillation; nightmares and insomnia in CVD; C vitamin intake in heart failure; depression in ICD recipients and family care givers and frailty in AMI were held. CESAR member Prof Anna Strömberg presented the development of different health techniques for example new tools in monitoring symptoms in patients with heart failure.  Photo: Maria Liljeroos.

Christina Andreae, PhD talked about physical activity and appetite in heart failure. Patients who are more physical active have better appetite both at short and long-term follow-up and therefore health care professionals should recognize physical activity and appetite jointly as physical activity might improve appetite and poor nutrition. Photo: Anna Strömberg.

In a MAIN event, Janet E Fulton talked about physical activity as the most important component in maintaining CVD health. In the same session, prof Rusell Pate presented that individuals knowledge and skills are key to achieve physical activity goals, he also stressed that local laws and regulations, relations between organizations, social institutions, families, friends and social network are of importance to achieve global physical activity goals.    

Every steps counts! Walking 2000 more steps per day associate with 8% lower risk for having adverse patient outcomes! Presented by William E Kraus, Durham, NC.

Wendy Dusenbury presented that sexual dysfunction in stroke is common and affect both men and women. Health care providers should open up for questions about sexual dysfunction in stroke rehabilitation programs. Interventions targeting both patient and partner are needed.

CESAR member prof Tiny Jaarsma moderated an interesting session title “Challenging issues and emerging therapies in the management of sexual dysfunction after CV events”. Photo: Maria Liljeroos

Even though the first study of sodium restrictions was published 1941 there is still hot ongoing discussions on how sodium restrictions affect patients with heart failure.

This was a full packed session, very enjoyable panel discussion of pros and cons on sodium restrictions in heart failure.   

Nice art from Poland by Magdalena Abakanowicz 2003, Chicago 13 Nov 2018

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Greetings from a nice windy City Chicago!

Christina Andreae

CESAR medlemmar har fått ett anslag från FORTE 3.9 miljoner för forskning om effekter av teleyoga på fysisk funktionsförmåga, hälsorelaterad livskvalitet, psykiskt välbefinnande, biomarkörer, sömn och kognition hos personer med långvarig sjukdom. Huvudsökande var Anna Strömberg och medsökande var CESAR medlemmarna Tiny Jaarsma, Ingela Thylén, Leonie Klompstra, och Peter Johansson samt kardiolog Urban Alehagen, hälsoekonom Jenny Alwin och Lottie Orvelius omvårdnadsforskare inom intensivvård. Projektet genomförs på universitetssjukhuset i Linköping, Vrinnevisjukhuset i Norrköping och Länssjukhuset Ryhov i Jönköping.

 Sammanfattning av ansökan: Många äldre personer med långvarig sjukdom är fysiskt inaktiva och har svårt att lämna hemmet för att delta i rehabilitering. Vår hypotes är att teleyoga i hemmet med en yogainstruktör och andra deltagare i grupp via weblänk och instruktioner hur man dagligen själv gör medicinsk yoga med hjälp av en app kan vara en metod för att öka psykisk och fysisk livskvalitet, den fysiska funktionen och förmågan att klara av dagliga aktiviteter.

Medicinsk yoga är en form av Kundaliniyoga med enkla rörelser, andningsövningar och meditation. Yoga har visat effekt på livskvalitetet, men tidigare studier har endast inkluderat små selekterade urval. För äldre personer med långvarig sjukdom kan det vara svårt att delta i vanliga yogaklasser. Vi har utvecklat en teleyoga intervention och vill nu utvärdera effekterna med avseende på livskvalitet, fysisk funktionsförmåga, symtom på ångest och depression, biomarkörer för stress och inflammation, sömn och kognition hos äldre personer med långvarig sjukdom. Vi kommer även att mäta sjukvårdskonsumtion, upplevelser av och tillfredställelse med yogan och tekniken. Utvärderingen sker genom att 150 äldre personer över 65 år med långvarig sjukdom rekryteras från tre sjukhus (ett universitetssjukhus och två länssjukhus) och lottas till en intervention med medicinsk yoga i hemmet med teknikstöd eller ett individualiserat träningsprogram. Teleyogan kommer att omfatta yogasessioner i grupp, 2 gånger/vecka som leds av en certifierad yogainstruktör via weblänk till en surfplatta kombinerat med en app i surfplattan med instruktioner hur man genomför medicinsk yoga på egen hand mellan de instruktörsledda yogasessionerna. Data om livskvalitet, funktionsförmåga, ångest och depression, biomarkörer, sömn och kognition kommer att samlas in vid baslinjemätning, efter 3 och 6 månader. Denna studie tar ett nytt grepp på rehabilitering av långvarigt sjuka äldre genom att utvärdera en medicinsk teleyoga på distans i hemmet.

Med vänlig hälsning

Anna

The 26^th-29^th of May I went to the Heart Failure Congress 2018, Including the World Congress on Acute Heart Failure in Vienna, Austria. The congress had over 5750 participants from over 80 countries. To see all the tweets during this congress, search for the #HeartFailure2018.

This year there was a lot of interesting talks and we would like to highlight the presentations given by members of the CESAR group.

Dr Tiny Jaarsma gave a talk about sex and heart disease. Pointing out that heart disease can lead to sexual problems. Furthermore, patients think that sexual counseling should be part of cardiac rehabilitation, which is often not a subject that was discussed. Patients prefer to receive written material and/or individual discussions. We should remember, according to Dr. Anna Strömberg, that patients with a LVAD are going through a transition in life and that there are psychosocial challenges in patients with an LVAD. See her take-home messages in the pictures below.

In the late breaking trials, the results of the HF-Wii study were discussed, which is a study conducted by Tiny Jaarsma, Anna Strömberg, Jan Mårtensson and Leonie Klompstra. This study proves that exergaming (being physical active through video gaming) positively influences exercise capacity and wellbeing of patients with heart failure. To see an interview about this study during the interview, please click here. In a poster presenting a sub-study of the HF-Wii showed that exergaming could also be feasible for patients with a LVAD, and patients especially liked to exergame with their grandchildren.

There was also a great session on alternative ways to be physically active in patients with heart failure. One of the alternative ways was presented by Anna Strömberg: medi-yoga. To read more about medi-yoga click here.

Another alternative way, again using exergaming, was presented by Tiny Jaarsma.

Leonie had two poster presentations, together with Tiny Jaarsma & Anna Strömberg, on the importance of objective measurements to assess physical activity.

Picture by @Angie_Durante89

Hanna Allemann also presented a poster. This study focus on perceived social support and health related quality of life in persons with heart failure and implantable cardioverter defibrillator (ICD).

Please safe the date for next years’ Heart Failure congress 2019, 25-28^th of May 2019 in Athens, Greece.

Hanna Allemann & Leonie Klompstra

Every year we have a national cardiac congress organized by the Swedish Heart Foundation. A lot of CESAR members participate in this congress every year. This year we had nice oral presentation, poster presentations and moderated poster sessions. An impression of our activities you can see in the pictures below.

15 and 16 of April 2018 international researchers had a 2-day meeting at LiU’s campus Norrköping.

Tiny Jaarsma, Anna Strömberg and Leonie Klompstra welcoming all.

After an intense collaboration of 5 years with colleagues from 10 centers that included patients in the HF-Wii study we organized 2 days of presentations, discussions and practical instruction. Our research colleagues from Sweden (Linköping, Norrköping, Nyköping, Jönköping and Stockholm) and colleagues from Italy, Israel, Germany, Netherlands and USA collected data from in total 605 patients in 10 centers.

Scientific discussions included intention to treat and per protocol analysis and optimal dissemination.  We also presented first outcomes (positive results of playing an exergames), experiences of patients and planned analysis and sub-studies.

A visit to the local patient organization to learn on implementation of the results completed 2 inspiring days.

Part of the international research group at ’Föreningen HjärtLung Norrköping.

To read more about the study please visit our website: www.hf-wii.com or follow us on twitter @HFWii

Dear all,

The 21^st – 22^nd of March I was invited to be speaker for the Heart Failure Association Training Workshop on Rehabilitation and Long-Term Management of Heart Failure Patients in Pisa Italy, a course of the European Society of Cardiology. This was such an honour, especially because I attended this course myself as a PhD student four years ago.

The first day of the workshop we learned a lot about the guidelines for rehabilitation and prevention and there were presentations on Acute setting/post-acute setting – first steps in initializing cardiac rehabilitation. Additionally, there were two live sessions from the cardiac clinic in the hospital of Pisa (Fondazione Toscana Gabriele Monasterio per la Ricerca Medica e di Sanità Pubblica). One live demonstration on early mobilization and physical reconditioning in acute setting and the second on cardiopulmonary exercise testing.

In the evening we visit the Acient Camposanto in Piazza dei Miracoli and had dinner with all the participants and speakers in the course. A perfect ending of an excellent first day.

The second day the presentations were on phase two in rehabilitation, emerging scenarios in heart failure: case presentations and multidisciplinary approach in rehabilitation. I gave a case presentation on tele-rehabilitation and Wii gaming and a presentation on how to deal with vocational, sex and other crucial items in rehabilitation. On sexual counseling in rehabilitation I wrote a blog for the early career blogging of the American Heart Association. There is a very nice online web-seminar of sexual counseling in cardiac patients on the website of the European Society of Cardiology, if you would like to learn more about this subject.

Leonie Klompstra

Ghassan Mourad has a collaboration with the research group “Emergency, Cardiovascular and Critical Care Research (ECCCR) Group” led by Professor Tom Quinn at Kingston and St George’s Joint Faculty of Health, Social Care and Education in London. The ECCCR group was launched at the 28^th February 2018 and Ghassan Mourad was present at the launch to present his RCT “Patient and societal benefits of guided internet-delivered cognitive behaviour therapy for patients with non-cardiac chest pain”.