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réadaptation cardiaque

réadaptation cardiaque. invité par le Dr Thierry Pepersack , juin 2017. âge , comorbidités : faut-il arrêter? Dr R aymond Kacenelenbogen Chef de la Clinique de Réadaptation cardiaque, CHU St Pierre Président du Working group Réadaptation et Prévention cardiovasculaire - BSC.

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réadaptation cardiaque

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  1. réadaptation cardiaque • invité par le Dr Thierry Pepersack, juin 2017 • âge , comorbidités: faut-il arrêter? • Dr Raymond KacenelenbogenChef de la Clinique de Réadaptation cardiaque, CHU St PierrePrésident du Working group Réadaptation et Prévention cardiovasculaire - BSC

  2. La réadaptation cardiaque: • Une affaire d’amitié • ‘comme ma mère’… • Mais aussi des arguments solides ‘EBM’ ou autres

  3. CardiacRehabilitationOutcomes: Impact of Comorbidities and AgeJennifer Listerman • Journal of cardiopulmonaryrehabilitation and prevention

  4. CMI: INDEX DE COMORBIDITE (>2)

  5. PCS (PHYSICAL COMPONENT SCORE DU MEDICAL OUTCOME STUDY) • plus âgé, les comorbidités influencent moins

  6. MCS • c'est bon pour le moral...

  7. Hf(score) & vitesse Insuffisance cardiaque • marche 4m: , , m/s • témoin de la ‘frailty’ • Valeur pronostique >1 0.67-1 < 0.67

  8. American College of CardiologyFoundation Giovanni Pulignano et al. JCHF 2016;4:289-298

  9. SimplifiedFriedcriteria for FRAILTY Frail = 3 or more criteriapresent ( pre-frail = 1 or 2 criteria.) • Friedphenotype

  10. stain-castellcorrelation marche-Fried

  11. SPPBshort physical performance battery

  12. da cmaracanada-brésil • sppb + ==> frailty + • AUC=0.8

  13. Arch Phys Med Rehabil. 2014 Apr;95(4):753-769.Physical exercise interventions for improving performance-based measures of physical function in community-dwelling, frail older adults: a systematic review and meta-analysis.Giné-Garriga M1, Roqué-Fíguls M2, Coll-Planas L3, Sitjà-Rabert M4, Salvà A3. • SPPB +2 • RC améliore la fragilité

  14. A Multidisciplinary Intervention to Prevent the Readmission of Elderly Patients with Congestive Heart Failure Michael W. Rich, M.D., Valerie Beckham, R.N., Carol Wittenberg, R.N., Charles L. Leven, Ph.D., Kenneth E. Freedland, Ph.D., and Robert M. Carney, Ph.D.

  15. http://www.nejm.org/na101/home/literatum/publisher/mms/journals/content/nejm/1995/nejm_1995.333.issue-18/nejm199511023331806/production/images/large/nejm199511023331806_t3.jpeghttp://www.nejm.org/na101/home/literatum/publisher/mms/journals/content/nejm/1995/nejm_1995.333.issue-18/nejm199511023331806/production/images/large/nejm199511023331806_t3.jpeg

  16. CirculationEDITORIALThe Clinical Frailty Scale: Upgrade Your Eyeball TestJonathan AfilaloCirculation. 2017;CIRCULATIONAHA.116.025958Originally published March 16, 2017

  17. Cardiac Rehabilitation and Secondary Prevention for the Older Patient Recommendations: • Physicians should recognize that the older patient may have a high level of physical and psychological disability following a coronary event, as well as greater co-morbidity, and should be considered for rehabilitation services. (1, Level of Evidence B) • Elderly patients should be strongly encouraged to participate is a rehabilitation program, as the most powerful predictor of adherence to a rehabilitation program is the strength of the referring physician’s recommendation. (1, Level of Evidence B) • A comprehensive cardiac rehabilitation program should be considered for older cardiac patients. Such a program not only improves body dimensions and blood lipids, but also has been shown to improve quality of life, enhance mood state, and alleviate depression. (1, Level of Evidence B) • Older coronary patients of both sexes should be considered as prime candidates for aerobic exercise training, since this has been shown to result in significant gains in submaximal and maximal effort tolerance, improvement in symptoms, a loss of body fat and an increase in lean body mass, all without increased risk of complications or adverse events (1, Level of Evidence B)

  18. • When prescribing aerobic exercise for older cardiac patients, the initial training intensity should be low and progression gradual, with longer warm-up and cool-down and avoidance of high heat and humidity. Walking is the training mode of choice. (1, Level of Evidence C)

  19. • Resistance training should be considered for low-risk older coronary patients, since it has the potential to reverse the loss of lean tissue associated with aging, increase muscle mass and strength, improve balance, and allow activities of daily living to be carried out with greater ease and safety. (1, Level of Evidence C)

  20. Mr B: 65 yr-old manyou see him after a coronary event (NSTEMI)no heart failureno renal insufficiency Obese High cholesterol HTN Type2 Diabetes Smoking PAL= 1.1 All the Traditional Risk Factors + Inactivity

  21. votez pour RC Exercise-Based CR: 50% reduction in Re-Infarction

  22. Cardiac Rehabilitation Dr R.Kacenelenbogen Cardiac Rehabilitation Department CHU St Pierre ,Brussels

  23. CRUSADE long-term MORTALITY model: 43.000 NSTEMI patients ➔ Cox PH model Mean score= 32; Mean 3 y- mortality= 40% • Predictors: • Age, sex(M) • Heart Failure, hypotension • Low Weight • Creatinine, High Troponin • Target Organ Damages • Diabetes (1.24) • Smoking (1.21) ➔ not included ?? MrB: score 8, risk 15% at 3 years • Treatable CV Risk Factor:Only DIABETES is predictive (HR 1.24) , but < TOD But DIGAMI2 : no benefit of INSULIN HTN & Weight & hyperlipemia are REVERSED ! • target organ damages ++ prior stroke, PAD, MI, renal i.e. multiple vascular beds Am Heart J 2011;162:875-883

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