Background: The prevalence of cardiovascular diseases (CVD) is high worldwide. Occupational therapy (OT) allows individuals to participate in activities of daily living (ADLs) and improves their quality of life. However, whether OT improves health-related quality of life (HRQOL), ADLs, fatigue, occupational performance, rehospitalization, and mortality in patients with CVD remains unclear. This study aimed to determine whether OT improves HRQOL, ADLs, fatigue, occupational performance, rehospitalization, and mortality in patients with CVD using a systematic review and meta-analysis.

Methods and Results: A literature search of 3 databases in October 2024 yielded 4 RCTs on OT in CVD patients. Two trials (n=208) assessed HRQOL, while 2 others (n=220) examined ADLs. One trial (n=23) evaluated fatigue and occupational performance, and another (n=93) assessed rehospitalization and mortality. Due to insufficient data on HRQOL and ADL improvement in 1 trial, a meta-analysis was not feasible. Similarly, a meta-analysis of fatigue, occupational performance, rehospitalization, and mortality could not be performed due to the limited number of studies.

Conclusions: The results showed no clear evidence that OT improves HRQOL or ADLs in patients with CVD.

Background: Data on cardiac rehabilitation (CR) outcomes in patients with cardiovascular disease (CVD), frailty, and multimorbidity in post-acute settings are limited. This study aimed to evaluate the feasibility and efficacy of individualized, multidisciplinary CR in convalescent rehabilitation hospitals (cRHs).

Methods and Results: This multicenter, prospective, observational study included 72 consecutive patients transferred from acute care hospitals. Personalized CR programs were implemented in cRHs. Primary outcomes were changes in the Barthel Index (BI) and functional independence measure (FIM) scores. Secondary outcomes included assessments of physical and cognitive function, and nutritional status. Mean participant age was 78.6±11.8 years. Prior to admission, 51.4% experienced acute decompensated heart failure (ADHF). The average length of stay was 59.5±39.2 days. BI and FIM scores improved from admission to discharge. The following parameters improved: Short Physical Performance Battery, knee extensor strength, comfortable gait speed, 6-min walk distance, New York Heart Association classification, and cognitive function (Mini-Mental State Examination). Discharge dispositions included 53 (73.6%) home discharges, and 19 (26.4%) outpatient CR post-discharges. Patients with post-ADHF and patients with other conditions both showed functional improvements, but ∆BI and ∆FIM were lower in the post-ADHF group.

Conclusions: Tailored multidisciplinary CR in cRHs effectively improves daily living activities and physical and cognitive outcomes in patients with CVD with complex conditions. Expanded use of these hospitals may help address clinical challenges.

Background: Frailty is a significant prognostic risk factor for cardiovascular disease and it can lead to poor quality of life due to malnutrition, fatigue, and reduced physical activity. However, few studies have investigated how frailty affects older patients participating in cardiac rehabilitation (CR) on health-related quality of life (HRQoL).

Methods and Results: Between November 2015 and December 2016 at Juntendo University Hospital, 217 patients (mean age 74.6±5.8 years; males 67%) participated in CR. Patients completed self-evaluations using the 36-item Short Form Survey (SF-36) and the Kihon Checklist (KCL) at the baseline of CR. The patients were divided into 3 groups: frailty group (n=81; 37%); pre-frailty group (n=71; 33%); and non-frailty group (n=65; 30%). Based on the KCL findings, we compared demographics, clinical measures, and SF-36 scores among the 3 groups. Sex, body mass index, 6-min walking distance, hemoglobin level, and low-density lipoprotein cholesterol differed significantly among the 3 groups. All SF-36 items also showed significant group differences; the frailty group scored lower than the other 2 groups on the physical component summary and mental component summary (MCS). Furthermore, the frailty group had a lower MCS score than the average Japanese age level.

Conclusions: Frail older patients undergoing CR experience significant deterioration in both physical and mental dimensions of HRQoL.

Background: Because bystander performance of cardiopulmonary resuscitation in out-of-hospital cardiac arrest cases is influenced by the number of rescuers/bystanders, we assessed the relationship between the presence of other people and performance of rescue actions in an actual emergency situation.

Methods and Results: A cross-sectional study was performed using data from an anonymous self-administered questionnaire-based survey that included laypersons who had encountered emergency situations during the past 5 years. Based on their responses related to the presence of other people, laypersons were divided into 2 groups: “single-bystander” (absence of others) and “multiple-bystanders” (presence of others). The primary outcome was any rescue action(s) performed by laypersons during an emergency. A total of 1,219 laypersons were eligible for our analysis; 69 (5.7%) encountered emergencies in which others were absent (single-bystander group) and 1,150 (94.3%) encountered emergencies in which others were present (multiple-bystanders group). The proportion of laypersons who performed any rescue actions was 95.7% in the single-bystander group and 73.8% in the multiple-bystanders group.

Conclusions: The proportion of laypersons who performed any rescue actions was lower when other people were present compared with when they were absent.

Background: Dapagliflozin is clinically beneficial in heart failure (HF). However, how these clinical benefits translate into economic burden reduction is unclear. With IMPLICATION HF, we projected the reductions in HF events and costs that would result from dapagliflozin use in Japan using a cost offset model.

Methods and Results: The modeled population comprised symptomatic HF patients from the DAPA-HF and DELIVER trials. We compared the event incidences and associated costs between HF treatment with and without dapagliflozin, using the prevalence, event rates, and event costs of HF in Japan from published literature, as well as the treatment effects of dapagliflozin from the pooled meta-analysis of DAPA-HF and DELIVER. The cumulative number of events (HF hospitalization [hHF], cardiovascular [CV] death, and all-cause death) and associated costs (hHF, CV death, total) were projected. Cost offsets were calculated according to the difference in event-related costs between HF treatment with and without dapagliflozin. Dapagliflozin was estimated to prevent 63,770 hHF events (number needed to treat [NNT] 20), 11,613 CV deaths (NNT 108), and 16,141 all-cause deaths (NNT 78), as well as reducing hHF and CV death costs by JPY62.7 billion and JPY16.6 billion, totaling JPY79.3 billion over 1 year in Japan. The sensitivity analyses corroborated these findings.

Conclusions: The addition of dapagliflozin to HF treatment is projected to provide economic benefits to the Japanese healthcare system.

Background: Serum N-terminal pro-B-type natriuretic peptide (NT-proBNP) values after initiating sacubitril/valsartan (Sac/Val) are considered a favorable prognostic factor in patients with heart failure (HF). However the relationship between the trajectory of repeated NT-proBNP measurements and cardiovascular events after Sac/Val remains uncertain.

Methods and Results: A Japanese nationwide multicenter study enrolled 995 patients who were prescribed Sac/Val from August 2020 to August 2021. Of them, 434 patients who had a complete set of NT-proBNP measurements were divided into 3 groups: sustained-responder group (n=129), with ≥10% reduction in NT-proBNP at 1 month and further ≥10% reduction at 3 months; transient-responder group (n=161), with ≥10% reduction at 1 month but not at 3 months; and non-responder group (n=144), without ≥10% reduction at 1 month. There were no significant differences in the mean Sac/Val dose at each measurement point among the 3 groups. During a median follow-up of 456 (interquartile range: 371–549) days, the primary endpoint, which was either cardiovascular death or hospitalization for HF, occurred in 78 patients. Kaplan-Meier analysis revealed that the sustained-responder group had a significantly higher event-free survival rate among the 3 groups (Log-rank P<0.001).

Conclusions: Repeated NT-proBNP monitoring and the pattern of the NT-proBNP trajectory after Sac/Val may be helpful in optimizing HF therapy and understanding the prognosis of HF.

Background: Transthyretin amyloid cardiomyopathy (ATTR-CM) is increasingly recognized as a major cause of heart failure in elderly patients with left ventricular hypertrophy. Although tafamidis was approved in 2019 following the ATTR-ACT study, its real-world survival impact in community settings remains unclear.

Methods and Results: This retrospective study analyzed 117 patients diagnosed with ATTR-CM at a single center from 2015 to 2024, with 75 receiving tafamidis and 42 untreated. Among the 83 patients who underwent genetic testing, all had the wild-type genotype. ATTR-CM diagnoses increased significantly after the advent of ^{99 m}Tc-pyrophosphate scintigraphy and tafamidis. Kaplan-Meier analysis showed significantly longer survival in tafamidis-treated patients. Multivariate analysis identified New York Heart Association (NYHA) functional class, left ventricular wall thickness, N-terminal prohormone of brain natriuretic peptide (NT-proBNP) levels, and tafamidis treatment as independent survival predictors. Tafamidis treatment was associated with significantly improved survival in patients who were younger, had a less advanced NYHA functional class, and lower levels of NT-proBNP and troponin T. In contrast, its survival benefits were marginal in patients with older age, higher NYHA functional class, elevated NT-proBNP levels, and increased troponin T levels.

Conclusions: In this real-world cohort, tafamidis treatment was significantly associated with better survival in ATTR-CM patients, particularly when initiated in the early stage. Therefore, early detection and timely initiation of treatment are critical for optimizing clinical outcomes in this increasingly recognized condition.

Background: No previous studies have evaluated the effect of an aspirin-free strategy for patients undergoing staged percutaneous coronary intervention (PCI).

Methods and Results: We conducted a post hoc subgroup analysis in patients undergoing staged PCI within 1 month in STOPDAPT-3 (n=6,002), which randomly compared prasugrel monotherapy with dual antiplatelet therapy (DAPT) in patients with acute coronary syndrome or high bleeding risk. The co-primary endpoints were major bleeding (Bleeding Academic Research Consortium 3 or 5) and cardiovascular events (a composite of cardiovascular death, myocardial infarction, definite stent thrombosis, or stroke) at 1 month. There were 814 patients undergoing staged PCI within 1 month (no-aspirin group, n=401; DAPT group, n=413). The median interval from randomization to the first staged PCI was 8 (interquartile range 5–13) days. More than 90% of the patients received assigned antiplatelet agents at all staged PCI procedures. The effect of no-aspirin relative to DAPT was not different for the co-primary bleeding (3.74% vs. 1.94%; HR 1.94; 95% CI 0.82–4.57) and cardiovascular (3.49% vs. 2.42%; HR 1.44; 95% CI 0.64–3.25) endpoints. The no-aspirin group compared with the DAPT group had a numerically higher incidence of the co-primary cardiovascular endpoint, which occurred after the first staged PCI procedure (2.49% vs. 1.21%; HR 2.07; 95% CI 0.71–6.05).

Conclusions: An aspirin-free prasugrel monotherapy relative to DAPT had numerically higher risks of cardiovascular and major bleeding events in patients undergoing staged PCI at 1 month.

Background: Obesity is well-established risk factor of heart failure (HF); however, “obesity paradox” has been described in symptomatic HF patients. The STEP-HFpEF study suggested that once-weekly subcutaneous semaglutide might improve outcomes in patients with obesity-related HF. We explored the prevalence of obesity-related eligibility for semaglutide treatment among patients with acute decompensated heart failure (ADHF) and evaluated their prognoses.

Methods and Results: We analyzed data from 1,017 ADHF patients (median, 81 years; 44.2% female) enrolled in the CURE-HF registry. We assessed prevalence of obesity-related eligibility for semaglutide administration and examined the association between this eligibility and all-cause death over a median follow-up of 2.7 years. There were 73 patients (7.2%) who were semaglutide-eligible and they had a higher proportion of diabetes mellitus than patients who were semaglutide non-eligible (64.4% vs. 26.4%, P<0.001). Kaplan-Meier analysis indicated that semaglutide-eligible patients had a significantly lower all-cause mortality rate than non-eligible patients (log-rank P=0.005). After adjustment for demographic characteristics, there was no significant difference in mortality rate between the 2 groups (adjusted hazard ratio 0.63, 95% confidence interval (CI) 0.34–1.17, P=0.14). In the propensity score-matched cohort, we did not observe a significant difference in mortality rate (log-rank, P=0.79).

Conclusions: Almost 7.2% of the ADHF patients were semaglutide-eligible. Our findings did not affirm the “obesity paradox” in semaglutide-eligible HF patients after adjusting for demographic factors.

Background: Persistent left ventricular hypertrophy (LVH) after surgical aortic valve replacement (SAVR) for aortic stenosis (AS) worsens prognosis. We investigated predictors of LVH regression 1 year after SAVR in AS patients, including patient-prosthesis mismatch (PPM) and valvuloarterial impedance (Zva).

Methods and Results: We retrospectively studied 175 patients who underwent SAVR for AS at Jichi Medical University between 2014 and 2019. Echocardiography was performed at preoperative baseline, 1-week postoperative, and 1-year postoperative. The left ventricular mass index (LVMI) regression rate (RR) was defined as the difference between baseline LVMI and 1-year LVMI divided by baseline LVMI. Patients were divided into 2 groups based on their median LVMI RR as follows: (1) a poor LVH regression (PR-LVH) group with values below the median LVMI RR; and (2) a good LVH regression (GR-LVH) group with values above the median LVMI RR. The median LVMI RR was 25.4%. There were 88 (50.3%) patients in the PR-LVH group. In the multivariable analysis, 1-week postoperative Zva (odds ratio [OR] 2.777; 95% confidence interval [CI] 1.584–4.869; P<0.001) and baseline LVMI per 10-unit increment (OR 0.974; 95% CI 0.960–0.988; P=0.001) were independent predictors of PR-LVH. The receiver operating characteristic curve analysis identified Zva ≥3.5 mmHg/mL/m²as a cut-off value associated with PR-LVH.

Conclusions: One-week postoperative Zva was a better predictor of improved LVH at 1 year after SAVR than PPM.

Background: The cardio-ankle vascular index (CAVI) is an important marker of arterial stiffness, providing a blood pressure-independent assessment of vascular function. However, the clinical significance of low CAVI values remains unclear. Some connective tissue diseases are associated with aortic diseases due to intrinsic arterial wall abnormalities and may exhibit low CAVI values. This study aimed to investigate whether low CAVI is associated with these connective tissue diseases and succeeding aortic diseases.

Methods and Results: This was a single-center, retrospective observational study conducted at Juntendo University Hospital. A total of 17,364 patients aged 20–80 years who underwent arterial stiffness analysis using CAVI were included. Low CAVI was defined as the lowest 2.5 percentile within each sex- and age-specific distribution. The prevalences of aortic diseases (dissection and/or aneurysm) and Marfan syndrome were similar between the between the low CAVI and normal CAVI groups (aortic disease, 3.99% vs. 3.99%, P>0.99; Marfan syndrome, 0.04% vs. 0.07%, P>0.99, for the low and normal CAVI group, respectively).

Conclusions: This study found no evidence that patients with low CAVI had an increased prevalence of aortic dissection, aortic aneurysm, or Marfan syndrome. Further studies are needed to clarify the clinical implications of low CAVI in vascular diseases.

Background: The effect of Intensified Multifactorial treatments on coronary atherosclerosis in PAtients with Coronary artery disease and Type 2 Diabetes Mellitus (IMPACT-DM) trial was designed to investigate the effects of intensified multifactorial treatments (IMT) on coronary plaque progression in patients with coronary artery disease (CAD) and diabetes.

Methods and Results: In this prospective, randomized, open-label, parallel assignment, multicenter study, eligible patients with diabetes who underwent successful percutaneous coronary intervention in culprit lesions are randomly assigned to receive either IMT or guideline-oriented standard treatments (Control) for 18 months. The IMT are managed according to strict target goals and step-by-step medical treatment protocols based on modern medical treatments. Target goals in IMT and Control groups are set to hemoglobin A1c <6.2% vs. <7.0%; low-density lipoprotein cholesterol <55 mg/dL for any type of CAD vs. <70 mg/dL for acute coronary syndrome, or <100 mg/dL for stable CAD; and blood pressure <120/80 mmHg vs. <130/80 mmHg, respectively. Non-culprit lesions are evaluated using intravascular ultrasound (IVUS) at post-procedure and 18 months follow up. The primary endpoint is absolute changes in percent plaque volumes in non-culprit lesions as assessed using IVUS from post-procedure to 18 months.

Conclusions: The IMPACT-DM trial will clarify the clinical benefits of IMT on non-culprit coronary plaques in patients with diabetes undergoing successful PCI in culprit lesions.

Background: There is recent evidence for the medical treatment of heart failure (HF) with mildly reduced ejection fraction (EF) and preserved EF (HFmrEF/HFpEF). However, in real-world settings, information on how cardiologists treat patients with HFmrEF/HFpEF, especially those with chronic, mild, and stable HF or newly diagnosed HF, is lacking. In other words, we do not know when cardiologists should start and intensify medical treatment, which drugs they should choose, or why. To answer these questions, we will conduct an observational study of HFmrEF/HFpEF. Here, we describe the rationale and protocol of this observational study.

Methods and Results: This study will explore the therapeutic status of approximately 4,200 patients who were diagnosed or newly diagnosed with chronic HFmrEF/HFpEF (LVEF >40%) at approximately 70 cardiology clinics and hospitals. After enrolment, physicians will check whether the current medical therapy is appropriate for each patient and initiate or intensify HF medical therapy appropriately. The primary endpoints will be: (1) the proportion of patients within the categories of reasons for changing prescriptions at visit 1 of HF medical therapy and (2) a composite of unexpected HF hospitalization and all-cause death in a 2-year follow-up.

Conclusions: This registry will uniquely confirm the current treatment status of patients with HFmrEF/HFpEF in real-world settings.