Ehime Prefecture has the highest heart failure mortality rate among men and women in Japan. Healthy life expectancy is low nationwide, which may be related to sarcopenia and frailty. Uwajima City contains a progresses aging of the population in the Ehime Prefecture. Therefore, preventing heart failure requires treatment and patient education not only for the underlying disease, but also for the complications associated with aging, such as sarcopenia and frailty. In 2020, we began working with the fitness club LocomoK.O to focus on prevention after the onset of disease and prevention before onset. We have commenced surveys of healthy older adults living in the community in Uwajima City, including the Short Physical Performance Battery, physical functions such as handgrip strength, and body composition assessment using in-body tests. The data showed that the rate of sarcopenia was extremely high, at 70% in patients with acute heart failure and 39% in the healthy older group, and that 24% of patients with acute heart failure had severe sarcopenia. Based on the collected data, we started health seminars in 2023 to educate citizens about the disease to prevent the onset and recurrence of heart disease, which is in line with the current situation in Uwajima City. We hope that our activities will help those struggling with local medical care.

In recent years, the adverse effects of prolonged sedentary behavior in daily life, so-called ‘sitting too much’, on health have been pointed out. Sedentary behavior is defined as ‘all waking behavior in which the energy expenditure in a sitting, semi-recumbent, or recumbent position is 1.5 metabolic equivalents or less’. Even if a person engages in the level of physical activity recommended in the guidelines, sitting for too long at other times may increase the risk of developing various diseases and death. For patients with cardiovascular disease, a comprehensive cardiac rehabilitation program that systematically includes not only medical treatment but also exercise therapy, patient education, and disease management is extremely important. Also, differences in sedentary behavior during the acute and recovery phases are known to affect physical function and activities of daily living at the time of hospital discharge. Here, we discuss cardiac rehabilitation that addresses sedentary behavior and review the previous related research.

Approximately 7,000 ambulatory (outpatient) heart groups (AHG) with 125,000 patients who are physically active on a regular basis have been established in Germany since the mid-1960s. Following phase II cardiac rehabilitation (CR), patients in an AHG aim to meet their set CR goals in groups of up to 20 participants under the instruction of a competent exercise therapist, and with regular attendance by a physician. Physical activity is the dominant aspect; psychosocial and educative elements are integrated to stabilize secondary cardiovascular prevention. Patients are legally entitled by German rehabilitation law to participate in AHGs. According to current studies, only 13–40% of all patients attend an AHG after phase II CR. In 2019, special AHGs for patients with high cardiovascular risk (chronic heart failure) were established. In the future, special emphasis needs to be placed on the recruitment of more patients into AHGs, particularly for the known under-represented groups (i.e., women, older patients, patients with low socioeconomic status). Furthermore, AHGs have to be established for patients with special needs (e.g., adults with congenital heart diseases). To date, the efficiency of AHG participation has still not been sufficiently investigated. A case-control study analyzing the long-term results of AHG participation reported an improvement in physical performance, as well as a reduction in cardiovascular morbidity (54%) and medical costs (approximately 47%). More superior investigations in this field are needed.

Background: This study aimed to create a deep learning model for predicting phenotypic physical frailty from electronic medical record information in patients with cardiovascular disease.

Methods and Results: This single-center retrospective study enrolled patients who could be assessed for physical frailty according to cardiovascular health study criteria (25.5% [691/2,705] of the patients were frail). Patients were randomly separated for training (Train set: 80%) and validation (Test set: 20%) of the deep learning model. Multiple models were created using LightGBM, random forest, and logistic regression for deep learning, and their predictive abilities were compared. The LightGBM model had the highest accuracy (in a Test set: F1 score 0.561; accuracy 0.726; area under the curve of the receiver operating characteristics [AUC] 0.804). These results using only commonly used blood biochemistry test indices (in a Test set: F1 score 0.551; accuracy 0.721; AUC 0.793) were similar. The created models were consistently and strongly associated with physical functions at hospital discharge, all-cause death, and heart failure-related readmission.

Conclusions: Deep learning models derived from large sample sizes of phenotypic physical frailty have shown good accuracy and consistent associations with prognosis and physical functions.

Background: Aging has progressed in several regions of the world with more older patients experiencing acute cardiovascular disease. Impella is a percutaneous potent circulatory support device associated with substantial cost and potential device-related complications.

Methods and Results: We analyzed the Japanese nationwide registry, encompassing consecutive patients with cardiogenic shock using Impella. Among 5,718 patients treated between 2020 and 2022, we compared older patients (≥75 years) with younger patients. The primary outcome was the Kaplan-Meier estimated 30-day mortality, and the secondary outcome was Impella-related complications. The median age of the 5,718 patients was 69 (58–77) years, and 1,807 (31.6%) were older, with smaller body mass index, frequent acute coronary syndrome, and infrequent myocarditis. Comorbidities were frequently observed in older patients with a higher ejection fraction and less frequency of extracorporeal membrane oxygenation. Older patients had a higher 30-day mortality than younger patients (38.9% vs. 32.5%; P<0.0001). The 30-day mortality was statistically equivalent among older subsets (75–79 vs. 80–84 vs. ≥85 years). Device-related complications similarly occurred similarly among the older subsets, except for a modest increase in cardiac tamponade and limb ischemia. Older age, body mass index, myocarditis, prior arrhythmia, shock severity, renal and hepatic impairment, and limb ischemia were associated with 30-day mortality.

Conclusions: The selected older patients using Impella exhibited modestly higher 30-day mortality with similar safety profiles. A longer follow up and optimal patient selection are important.

Background: Clinical impact of inframalleolar (IM) angioplasty in patients with chronic limb-threatening ischemia (CLTI) is still controversial.

Methods and Results: This single-center, retrospective study included 168 patients with CLTI and tissue loss who underwent angioplasty for IM lesions. Angiographic follow up was performed at reintervention between April 2010 and December 2020. The outcome measure was the incidence of angiographic deterioration characterized by severe restenosis or occlusion of mildly stenotic lesions, occlusion of severely stenotic lesions, or extension of the occlusion length at reintervention. Angiographic deterioration was observed in 47.7% of patients, with the majority attributed to occlusion in severely stenotic lesions. Multivariate analysis revealed that a distal reference vessel diameter ≤1.0 mm in the initial angioplasty (hazard ratio 1.91 [95% confidence interval 1.20–3.04]; P=0.006) was significantly associated with angiographic deterioration of IM lesions at reintervention.

Conclusions: Angiographic deterioration occurred in approximately half of the patients with CLTI who underwent IM angioplasty and reintervention.

Background: Data on the impact of valve position on clinical outcomes in patients with atrial fibrillation (AF) and bioprosthetic valves (BPVs) are limited.

Methods and Results: The BPV-AF Registry was a multicenter, prospective, observational study involving 894 patients with BPVs and AF. In this post-hoc substudy, patients were classified according to BPV position: aortic (n=588; 65.8%), mitral (n=195; 21.8%), or both (n=111; 12.4%). The primary outcome was a composite of stroke/systemic embolism, major bleeding, heart failure requiring hospitalization, all-cause death, or BPV reoperation. During a mean follow up of 15.3±4.0 months, the primary outcome occurred in 90 (15.3%) patients (12.7/100 patient-years) in the aortic group, 25 (12.8%; 10.2/100 patient-years) in the mitral group, and 16 (14.4%; 11.8/100 patient-years) in the both-valves group (log-rank P=0.621). The unadjusted and adjusted risks were not significant for the mitral and both-valves groups relative to the aortic group (unadjusted hazard ratio [95% confidence interval] 0.80 [0.52–1.25] and 0.92 [0.54–1.57]; adjusted hazard ratio 0.89 [0.51–1.54] and 1.10 [0.58–2.09], respectively). There was no significant difference in the incidence of stroke/systemic embolism or major bleeding among the 3 groups (log-rank P=0.651 and 0.156, respectively).

Conclusions: In patients with BPVs and AF, the risk for the composite outcome was comparable regardless of the BPV position.

Background: Constipation often coexists with heart failure (HF) and can cause increased blood pressure variability, which may increase the risk of repeated HF admissions. However, large-scale contemporary data regarding the prognostic effect of constipation in patients with HF are lacking.

Methods and Results: We retrospectively identified 556,792 patients admitted for HF for the first time and discharged alive in the fiscal years 2016–2021 using the Japanese Diagnosis Procedure Combination database. Constipation was defined as continued use of laxatives after discharge. We examined the association between constipation and 1-year HF readmission. The prevalence of constipation was 22.0% (n=122,670), which remained stable over the 6 years. Patients with constipation were older (82.7±10.1 vs. 79.3±12.8 years), more often female (53.5% vs. 48.0%), and received medications for HF more frequently at discharge compared with those without constipation. In the multivariable Cox proportional hazards model, constipation was significantly associated with a higher incidence of 1-year HF readmission (24.0% vs. 18.6%; adjusted hazard ratio [HR] 1.08; 95% confidence interval [CI] 1.06–1.10). This result was consistent with the result from the Fine-Gray model accounting for competing risk of death (subdistribution HR 1.08; 95% CI 1.06–1.09).

Conclusions: Constipation was associated with a higher risk of HF readmission after the first episode of HF hospitalization. Given the detrimental effect of constipation, further efforts are warranted to decrease constipation-related risk in patients with HF.