Research Appraisals
Evidence-based critical appraisals of the latest medical research, systematically evaluated using Oxford CEBM methodology.
Showing 18 appraisals
JMIR mHealth and uHealth
mHealth Technologies for the Care of Children With Congenital Heart Disease: Scoping Review
BACKGROUND: Mobile information technology (IT) is increasingly being used in the health care sector, and it can play a critical role in both the care of children with congenital heart disease (CHD) and the quality of life of their families. OBJECTIVE: This study aimed to conduct a scoping review of the application of mobile health (mHealth) technologies in the care of children with CHD. We summarized the forms of mHealth interventions and effects on CHD to provide a reference for future research in this field. METHODS: We searched PubMed; Embase; Web of Science; the Cochrane Library; CINAHL; China National Knowledge Infrastructure; Wanfang Data; the Chinese Biomedical Database; VIP Chinese Science and Technology Journal Database; National Guideline Clearinghouse of the United States; the website of the Registered Nurses' Association of Ontario, Canada; the Guidelines International Network; the American Heart Association; and the American Association of Cardiovascular and Pulmonary Rehabilitation. The search period was from the establishment of the databases to June 12, 2025. The retrieved literature was screened and analyzed. RESULTS: A total of 519 Chinese- and English-language articles were identified, with 44 (8.5%) studies meeting the inclusion criteria. The primary forms of mHealth interventions for patients with CHD included mobile apps, wearable devices, and remote monitoring equipment. The findings indicated that mHealth technologies could improve exercise capacity, nutritional status, psychological well-being, and quality of life in children with CHD. CONCLUSIONS: The application of mHealth in the care of children with CHD is feasible and demonstrates positive effects. Future research should emphasize peer education and patient privacy protection while further exploring remote education and health management based on theoretical frameworks and intelligent ITs to enhance quality of life for both children with CHD and their parents.
19 July 2026
Read appraisal →Journal of bodywork and movement therapies
Wearable technologies in neurorehabilitation and cardiac rehabilitation: A narrative review
BACKGROUND/OBJECTIVE: Wearable devices are sensor-based technologies capable of continuous physiological and movement monitoring, improving health tracking and clinical care. They can play a crucial role in clinical practice including cardiac and neurological rehabilitation, aiding in conditions as stroke, Parkinson and heart failure. These tools enhance treatment adherence and outcomes through remote, continuous, and personalized monitoring. By overcoming barriers of traditional rehabilitation, wearable devices offer cost-effective, accessible, and patient-centered solutions for chronic care. The purpose of this study is to evaluate the state of the art of the use of wearable devices in cardiology and neurology clinical rehabilitation practice. METHODS: A structured literature search was performed in PubMed, Embase, Web of Science, Scopus and Cochrane Library databases, for original studies published between 2014 and 2024 involving adult patients and clinical data. Only original studies with patient intervention or observation were included. RESULTS: Of the 25 studies included, 19 focused on neurology and 6 on cardiology, all exploring wearable devices in adult rehabilitation from 2014 to 2024. Neurological studies targeted conditions like stroke and Parkinson's disease, using robotic aids and virtual reality, while cardiac studies focused on activity monitoring and recovery support. Devices ranged from IMUs and sensor-equipped gloves to wrist-worn ECG monitors, with outcomes assessing motor function, heart rate, and rehabilitation adherence. Patient acceptance was generally positive, particularly in tele-rehabilitation contexts, although usability and long-term adherence were inconsistently reported. CONCLUSIONS: Wearable devices effectively improve neurological and cardiac rehabilitation by supporting personalized, data-driven therapies and remote monitoring, helping to monitor activity and therapeutic adherence. Overall, they promote better outcomes, patient autonomy, and access to care, although there is less evidence. Future studies should further investigate the utility of these devices in different rehabilitation settings.
1 July 2026
Read appraisal →Life sciences
Intermittent fasting and cardiometabolic responses under cardiac stress: a systematic review of preclinical studies
Intermittent fasting (IF) has emerged as a dietary strategy with benefits that extend beyond weight management and glycemic control. Although growing evidence supports its favorable effects on cardiometabolic health, the impact of IF under conditions of cardiac stress remains poorly characterized. Since clinical trials cannot ethically expose patients to acute cardiac stress during IF protocols, preclinical models are essential to elucidate its potential cardioprotective mechanisms. This systematic review aimed to synthesize the preclinical evidence on the effects of IF in models of cardiac stress. Following a registered protocol (PROSPERO:#CRD42023466215), we searched databases for preclinical studies evaluating IF under cardiac stress. Models included atherosclerosis induction, diet modulation, hypercholesterolemic mice, doxorubicin-induced cardiotoxicity, pulmonary arterial hypertension, myocardial infarction, ischemia-reperfusion injury, among others. All IF regimens, encompassing variations in timing, frequency, and type, were considered. Clinical trials, observational studies, reviews, meta-analyses, updates, guidelines were excluded. Thirty-two studies involving 451 predominantly male animals were included. Approximately 80% reported that IF improved cardiovascular outcomes, reducing blood pressure, cardiac hypertrophy, fibrosis, and ischemic injury while enhancing vascular and metabolic function. Mechanistically, IF protects the heart under stress by downregulating NF-κB, IL-1β, and TNF, and activating SIRT3 and AMPK pathways, improving mitochondrial function, lipid metabolism, and cardiac energy homeostasis. Cardioprotective benefits were dependent on fasting duration and regimen, emphasizing the importance of metabolic context. In conclusion, IF appears to enhance cardiovascular resilience under stress through multiple metabolic and molecular pathways. These findings support further clinical investigation of IF as a potential adjunct strategy for cardiometabolic protection under stress.
15 June 2026
Read appraisal →Annals of medicine
Predicting major adverse cardiovascular and cerebrovascular events in chronic heart failure: a machine learning study
BACKGROUND: Heart failure (HF) is a clinical syndrome characterized by impaired cardiac diastolic and systolic function due to structural or functional damage to the myocardium. HF represents the end-stage manifestation of many cardiac diseases. Therefore, early identification of high-risk patients is crucial. This study aims to utilize machine learning (ML) methods to develop and validate a model to predict major adverse cardiovascular and cerebrovascular events (MACCE) in patients with HF and identify its key predictive features. METHODS: This study is a retrospective cohort study. We enrolled a total of 271 patients, who were divided into training and testing sets. Baseline data, including cardiopulmonary exercise testing (CPET) parameters and laboratory tests, were collected for all participants. Based on the presence or absence of MACCE during follow-up, they were categorized into a No-event group and MACCE group. We developed seven ML models to predict the incidence of MACCE in patients with chronic heart failure (CHF) using CPET parameters. The predictive performance of these models was systematically compared, and model interpretability was evaluated using Shapley Additive exPlanations (SHAP). Subsequently, retaining only those with HF with preserved ejection fraction (HFpEF) for a sensitivity analysis. Additionally, a subgroup analysis was conducted between No-event group and Worsening HF (WHF) group. RESULTS: We used Boruta feature selection, four important predictive features were identified. Among the ML models constructed with these features, the Categorical Boosting (CatBoost) model demonstrated the best performance. SHAP analysis was applied to interpret the optimal model, revealing that lower values of heart rate recovery at 1 min (HRR1), as well as a higher carbon dioxide ventilation equivalent slope (VE/VCO2 slope), were associated with higher SHAP values-indicating greater importance in predicting adverse outcomes. CONCLUSION: HRR1 and VE/VCO2 slope can serve as independent predictors for the incidence of MACCE in patients with CHF. Both impaired HRR1 and an elevated VE/VCO2 slope serve as significant independent predictors of MACCE in the CHF population.HRR1 is an independent predictor of WHF in patients with CHF.
14 June 2026
Read appraisal →European heart journal
Wearable devices and cardiovascular health: revolutionizing remote monitoring and disease prevention
Wearable devices are transforming cardiovascular medicine by enabling continuous monitoring of physiologic and behavioural measures outside of traditional clinical settings. Smartwatches and activity trackers, the most widely used wearables, employ motion and biometric sensors to measure physical activity, sleep quality, heart rate, and rhythm. By converting health goals into objective, quantifiable measures, wearable devices empower patients to assume a more active role in their health while providing clinicians with novel opportunities for longitudinal, real-world assessment. Clinical applications span the cardiovascular continuum from lifestyle interventions targeting physical activity and sleep to the remote management of chronic conditions such as heart failure. Widespread clinical adoption of wearables remains limited by challenges, such as variability in device methodology, data outputs, validation, and intended use; incompatibility with existing electronic health records; and the lack of standardized, evidence-based workflows for clinicians to efficiently interpret and act upon wearable data. This review summarizes the current landscape of wearable technologies in cardiovascular medicine by highlighting key clinical applications, evidence gaps in the existing literature, the role of artificial intelligence, and barriers to implementation. We discuss strategies to enhance clinical integration and strengthen the current evidence base while also providing practical guidance to help clinicians navigate commonly encountered clinical scenarios.
16 May 2026
Read appraisal →Medical science monitor : international medical journal of experimental and clinical research
Improved Cardiac Function and Glycemic Control in Elderly Diabetic Patients Through Structured Case Management After CABG
BACKGROUND Elderly patients with both coronary heart disease (CHD) and diabetes mellitus (DM) undergoing off-pump coronary artery bypass grafting (CABG) face high risks of perioperative glucose fluctuations and impaired recovery. We evaluated the impact of a structured, multidisciplinary case management model on cardiac function and glycemic control in this population. MATERIAL AND METHODS This single-center, randomized controlled trial enrolled 168 elderly (≥65 years) patients with CHD and type 2 DM scheduled for off-pump CABG. Patients were randomized (1: 1) to a control group (CG, n=84; routine care) or an observation group (OG, n=84). The OG received routine care plus a 6-month multidisciplinary intervention including individualized cardiac rehabilitation, modified Mediterranean diet, psychological support, and intensified follow-up. The primary endpoint was 6-month left ventricular ejection fraction (LVEF); HbA1c was a key secondary endpoint. RESULTS All 168 randomized patients were analyzed. At 6 months, the observation group demonstrated significantly superior primary outcomes. LVEF was significantly higher in the OG (mean difference: 6.2%, P<0.001), and HbA1c was significantly lower (mean difference: 1.3%, P<0.001). The intervention group also showed significant improvements in secondary endpoints, including reduced left ventricular diameters (LVESD, LVEDD), an improved lipid profile (P<0.05), longer 6-minute walk test distance, and higher Diabetes-Specific Quality of Life (DSQL) and Activity of Daily Living (ADL) scores (P<0.0001). CONCLUSIONS Structured, multidisciplinary case management significantly improved cardiac function, metabolic control, and functional capacity in elderly diabetic patients after off-pump CABG, validating its efficacy for this high-risk group.
13 May 2026
Read appraisal →Current heart failure reports
Face-to-Face and Internet-based Cognitive Behavioral Therapy for Patients with Heart Failure: an Umbrella Review of Systematic Reviews and Meta-analyses
PURPOSE OF REVIEW: The present study aims to provide an up-to-date umbrella review of existing meta-analyses of randomized control trials (RCT) of cognitive behavioral therapy (CBT) among patients with heart failure (HF). RECENT FINDINGS: The umbrella review covered five meta-analyses published in the past five years with 18 primary studies (conducted between 2010 and 2022) of 1,687 non-duplicated patients aged 51.63 to 77.40. Primary studies originated from the USA, Sweden, Netherlands, China, Iran, and Philippines. Common benefits of CBT included depressive symptoms (89%), quality of life (56%), anxiety symptoms (39%), self-care (33%), 6-minute walk distance (33%), and health status (17%). Evidence varied depending on the timepoint of follow-up assessment and the specific measurement used to evaluate the outcome. No meta-analyses pooled the effect sizes for iCBT and analyzed the specific therapeutic elements in CBT. No meta-regression was performed. Individual participant data meta-analyses with meta-regression should be performed to identify common moderators and factors that can influence treatment adherence. The current research would also benefit from additional RCT evidence focusing specifically on iCBT for patients with HF.
12 May 2026
Read appraisal →BMJ open
Prevalence and types of anxiety disorders among patients with cardiac conditions and elevated HADS-A scores: findings from the initial screening phase of the Heart and Mind trial in Denmark
OBJECTIVES: To identify whether patients with arrhythmia, heart failure or ischaemic heart disease presenting with anxiety symptoms measured by the Hospital Anxiety and Depression Scale (HADS) have identifiable anxiety according to the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders (SCID) and, if so, which type of anxiety disorder based on the SCID. DESIGN: Initial screening data from the Heart and Mind randomised clinical trial. SETTING: Patients with arrhythmia, heart failure or ischaemic heart disease were screened using HADS, and patients with a HADS-anxiety (HADS-A) score≥8 were invited to participate. Participants were interviewed by trained cardiac nurses using the SCID to determine whether they met the criteria for anxiety and, if so, the type of anxiety disorder. RESULTS: Of the 7816 patients who completed the HADS questionnaire, 1803 (23%) had a HADS-A score≥8. Among these, 398 (22%) agreed to the SCID interview, and 336 (84%) met the diagnostic criteria for an anxiety disorder. The mean age was 61 years, with 40% being female. The mean HADS-A score was 11.3 (SD=2.7). The most common types of anxiety were generalised anxiety disorder (61%), panic disorder (23%) and specific phobia (8%). CONCLUSIONS: The majority of individuals identified by the instrument also met the diagnostic criteria for an anxiety disorder. Generalised anxiety disorder and panic disorder were the most prevalent subtypes. Anxiety was common across the cardiac population, underscoring the need for routine assessment and targeted intervention in clinical practice. TRIAL REGISTRATION NUMBER: NCT04582734.
12 May 2026
Read appraisal →Journal of medical Internet research
Application of Digital Health Technologies in Cardiac Rehabilitation for Patients With Coronary Heart Disease: Scoping Review
BACKGROUND: The high mortality and recurrence rates associated with coronary heart disease (CHD) impose substantial health care costs and economic burdens globally. Identifying effective interventions to improve patient outcomes is paramount. Digital health technologies (DHTs) offer novel solutions to overcome the challenge of low participation rates in traditional cardiac rehabilitation (CR). OBJECTIVE: This review aims to systematically map the scope of application, intervention objectives, and evaluation metrics of DHTs in CR for patients with CHD, thereby providing a structured evidence base for future research and practice. METHODS: This scoping review adheres to the Joanna Briggs Institute's methodology and is reported according to the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines. A systematic search was conducted across 5 major databases, PubMed, Web of Science, Embase, Cochrane Library, and EBSCO, covering the period from inception to February 2026. Inclusion criteria were developed based on the participants, concept, and context framework. Studies focused on the application of various DHTs within CR settings for patients with CHD. Eligible literature comprised randomized controlled trials, quasi-randomized controlled trials, and longitudinal before-and-after studies published in peer-reviewed journals. Two researchers (XZ and ZL) independently conducted literature screening and data extraction. Findings were presented through a comprehensive narrative synthesis and evidence gap maps. RESULTS: A total of 43 studies were included, predominantly randomized controlled trials (n=40). Findings revealed (1) diverse technological formats, categorized into 3 main types: digital health tools, real-time remote support, and asynchronous communication. Multitechnology combined interventions have become the mainstream model (36/43, 83.7%). (2) Intervention objectives were multifaceted, consolidating into 4 dimensions: motivation and guidance, knowledge and skills, monitoring and security, and social and group dynamics. (3) Evaluation metrics were multidimensional, encompassing clinical physiological indicators, health behaviors, patient-reported outcomes, service use rates, and technological feasibility. DHTs demonstrated positive effects in improving short-term physiological function and health behaviors; however, evidence remains insufficient regarding their impact on long-term clinical outcomes such as reducing adverse events. CONCLUSIONS: The innovation of this scoping review lies in integrating highly heterogeneous evidence to reveal the field's evolution from isolated tools toward systematic, integrated solutions. Research confirms that DHTs effectively overcome temporal and spatial constraints, enhancing rehabilitation accessibility and engagement. They serve as crucial strategic tools for bridging geographical disparities in health care resources and advancing equity in cardiovascular health services. However, the evidence base remains limited, including insufficient long-term efficacy data and inadequate exploration of vulnerable populations such as older people and those with low digital literacy. Future research urgently requires large-scale, long-term follow-up clinical trials, alongside enhanced studies on adaptability for specific populations and considerations of health equity. This will propel digital CR toward greater scientific rigor, universal applicability, and precision.
3 May 2026
Read appraisal →Journal of medical Internet research
Personalized Smartphone Messaging for Secondary Prevention After Percutaneous Coronary Intervention: Randomized Controlled Trial
BACKGROUND: Cardiac rehabilitation improves outcomes after percutaneous coronary intervention (PCI), but participation remains suboptimal due to barriers such as distance, cost, and lack of referral. Mobile health interventions may enhance accessibility and engagement. OBJECTIVE: This study evaluated the effectiveness and user acceptability of a smartphone messaging app (AnSim) in improving cardiovascular risk factors among patients who recently underwent PCI. METHODS: A 2-arm randomized controlled trial was conducted at 2 Korean hospitals; 120 patients who had undergone PCI within the prior month were randomized (1:1) to receive AnSim plus usual care (intervention) or usual care alone (control). The intervention comprised personalized messages tailored by behavioral stage and risk profile, delivered 6 times/week for 6 months. Outcomes were assessed at baseline, 6 months, and 9 months. The primary outcome was change in blood pressure (BP) at 6 and 9 months. Secondary outcomes were lipid profiles, hemoglobin A1c, BMI, smoking status, physical activity, and achievement of guideline-recommended risk-factor targets. User acceptability was assessed by questionnaire. RESULTS: Overall, 115 (95.8%; intervention: n=58, control: n=57) participants completed follow-up at 6 months and 110 (91.7%; intervention: n=54, control: n=56) at 9 months. At 6 months, systolic BP was 124.9 (SD 16.7) mmHg in the intervention group and 124.8 (SD 13.1) mmHg in the control group (between-group difference 0.1 mmHg, 95% CI -5.4 to 5.6), and diastolic BP was 80.2 (SD 11.4) mmHg vs 78.4 (SD 10.6) mmHg (difference 1.8 mmHg, 95% CI -2.3 to 5.9). At 9 months, systolic BP was 126 (SD 14.2) mmHg vs 128 (SD 15.4) mmHg (difference -2 mmHg, 95% CI -7.6 to 3.6), and diastolic BP was 80.8 (SD 13.2) mmHg vs 81.3 (SD 12.0) mmHg (difference -0.5 mmHg, 95% CI -5.3 to 4.3). No significant between-group differences were observed in secondary outcomes. In post hoc analyses, participants with above-median message reading were more likely to achieve ≥4 of 5 guideline-recommended risk-factor targets at 9 months (69% vs 19.2%; relative risk 3.59, 95% CI 1.57-8.18; P<.001) and logged more diary entries (mean difference 203.4 entries, 95% CI 79.3-327.5; P=.001). BP responders at 9 months read messages on more days than nonresponders (110.3 vs 83.3 d; mean difference 27 d, 95% CI 4.6-49.3; P=.02). Among survey respondents (54/60, 90%), 87% (47/54) found the messages helpful and 81.4% (44/54) wished to continue. Two events occurred in the control group (P=.50). CONCLUSIONS: This trial found no between-group improvement in BP with low-intensity personalized messaging compared to an attention-matched diary app, but exploratory analyses suggest engagement may be a key determinant of potential benefit. Unlike comprehensive app-based cardiac rehabilitation programs, AnSim provides scalable behavioral reinforcement that can be integrated into post-PCI follow-up with minimal burden. These findings support future pragmatic trials optimizing engagement strategies and evaluating longer-term clinical and implementation outcomes.
25 Apr 2026
Read appraisal →European journal of preventive cardiology
i-CARE: a smartphone-based intervention to enhance cardiac rehabilitation in coronary artery disease-a randomized controlled trial
AIMS: The global shortage of healthcare professionals creates challenges in managing chronic diseases. This study evaluated a remotely delivered, theory-based self-care support intervention, 'Internet-based CArdiac Rehabilitation Enhancement (i-CARE)', delivered through a smartphone application to enhance self-management in patients with coronary artery disease (CAD). METHODS AND RESULTS: In this assessor-blinded, two-arm randomized controlled trial conducted at two regional hospitals in Hong Kong, community-dwelling adults with angiographically confirmed CAD were randomly assigned (1:1) to standard care or the i-CARE intervention. i-CARE included personalized risk assessment, skill-building, and app-based support to improve self-care behaviours. The primary outcome was change in CAD self-care behaviours; secondary outcomes were self-reported health status, health-related quality of life (HRQoL), physiological, and biomarkers. Of 294 participants randomized (n = 147 per group), the i-CARE group showed significant greater improvements in self-care maintenance [β = 4.055, 95% confidence interval (CI) 1.420-6.691, P = 0.003] and self-care confidence (β = 5.609, 95% CI 1.089-10.129, P = 0.015) at 3 months, sustained at 6 months. For secondary outcomes, the intervention also resulted in significant reductions in systolic (β = -3.725, 95% CI -7.322 to -0.128, P = 0.042) and diastolic (β = -2.153, 95% CI -4.228 to -0.079, P = 0.042) blood pressure and improvements in HRQoL at 3 months (β = 0.208, 95% CI 0.073-0.343, P = 0.003), with persistent benefits for diastolic blood pressure and HRQoL sustained at 6 months. No significant differences were observed for cardiac-specific health status, blood glucose, lipid profile, or waist-to-height ratio. CONCLUSION: Remotely delivered i-CARE intervention effectively promote self-care among CAD patients and may help address critical healthcare workforce shortages, while also conferring secondary benefits in blood pressure and HRQoL. Cardiac rehabilitation is a comprehensive management approach with proven clinical benefits to delay disease progression. However, the participation rate in cardiac rehabilitation remains low due to common barriers such as time constraints and need for transportation to centres. Mobile health applications offer innovative solutions to overcome these barriers providing multidimensional support to meet the complex needs of coronary artery disease (CAD) patients and enhance their self-management capabilities. This study aimed to evaluate the effects of an internet-based Cardiac Rehabilitation Enhancement (i-CARE) intervention among community-dwelling adults with angiographically diagnosed CAD to enhance self-care behaviours. The findings showed promising potential of digital health interventions to improve self-care behaviours, blood pressure control, and health-related quality of life in CAD patients.
24 Apr 2026
Read appraisal →European journal of preventive cardiology
Aerobic exercise and cardiovascular outcomes in patients with diabetes undergoing percutaneous coronary intervention: a nationwide population-based study
AIMS: We investigated the impact of aerobic exercise on clinical outcomes in patients with diabetes undergoing percutaneous coronary intervention (PCI). METHODS AND RESULTS: We analyzed a nationwide prospective population database from the Korean National Health Insurance System. We included 8225 patients with diabetes who had undergone PCI and documented their aerobic exercise habits before and after the procedure (mean interval: 2.0 years). The patients were categorized into four groups: persistent non-exercisers, new exercisers, exercise discontinuers, and exercise maintainers. The primary outcome was major adverse cardiovascular events (MACE), a composite of all-cause death, myocardial infarction, revascularization, and heart failure. We assessed the risk of clinical events using inverse probability-weighted Cox proportional hazards models. During a mean follow-up of 4.9 years, exercise maintainers, discontinuers, and new exercisers were associated with a significantly lower risk of MACE compared to non-exercisers. The lowest risk was observed in exercise maintainers (maintainers: aHR, 0.78; 95% CI: 0.71-0.86; discontinuers: aHR, 0.88; 95% CI: 0.79-0.98; new exercisers: aHR, 0.89; 95% CI: 0.80-1.00). A J-curve relationship between the amount of aerobic exercise and adverse clinical outcomes was observed, with the lowest risk identified at 1000-1499 MET-min/week. Benefits diminished with exercise intensity ≥1500 MET-min/week. CONCLUSION: Aerobic exercise maintenance after PCI was associated with a reduced risk of cardiovascular events in patients with diabetes, with a moderate amount of exercise providing maximal benefit. Therefore, aerobic exercise is advisable for patients with diabetes undergoing PCI, and the optimal exercise dosage warrants further research. LAY SUMMARY: This large-scale prospective population study, based on the Korean National Health Insurance System, demonstrated that maintaining aerobic exercise in patients with diabetes undergoing percutaneous coronary intervention is significantly associated with a lower risk of cardiovascular events.A J-curve relationship was observed between the amount of aerobic exercise and clinical outcomes, with the lowest risk observed at 1000-1499 MET-min/week for both new exercisers and the entire study population.However, exercising beyond 1500 MET-min/week offers diminishing returns, highlighting the need for balanced exercise intensity.
24 Apr 2026
Read appraisal →European journal of preventive cardiology
A comprehensive analysis of the impact of high-intensity interval vs. moderate-intensity continuous training on global and regional myocardial function in patients early after acute myocardial infarction: the STRAICT randomized controlled trial
AIMS: This study aims to compare the effect of moderate-intensity continuous training (MICT) vs. isovolumic high-intensity interval training (HIIT) on left ventricular (LV) myocardial function early post-acute myocardial infarction (AMI). Training-induced changes were analysed at both global and segmental levels using advanced deformation echocardiographic imaging techniques. METHODS AND RESULTS: One hundred AMI patients were randomly assigned to participate in an 8-week training programme comprising either MICT (n = 50) or isovolumic HIIT (n = 50), starting within 6 weeks post-AMI. Before and after cardiac rehabilitation (CR), we carried out a comprehensive and detailed evaluation of myocardial function, including measurements of LV longitudinal strain (LS) and circumferential strain and torsional mechanics, LV myocardial work (MW) and mechanical dispersion [post-systolic shortenings (PSS)] indexes, and atrial strains. Mixed models were used to evaluate the effect of MICT and HIIT on speckle-tracking echocardiography parameter. Both MICT and HIIT resulted in a similar improvement in the amplitude and timing of LV LS (time effect P < 0.001 in each case), as depicted by the comparable increase in global LS [HIIT: -0.82%, 95% confidence interval (CI): -0.19/-61; MICT: -1.11%, 95% CI: -1.17/-0.51; time ∗ group P = 0.71], MW index and efficiency, constructive MW, and reduction in the number of PSS and wasted MW (time ∗ group P > 0.12 in each case) in the two groups. These improvements were observed in all myocardial territories, regardless of previous ischaemic risk status (culprit vessel-by-time-by-group interactions, P > 0.60 in each case). Circumferential strains remained unchanged in both groups while there was a trend (time ∗ group P = 0.04) for LV torsion to decrease for MICT (P = 0.06) and increase for HIIT (P = 0.36) after CR. Left atrial strains during the reservoir and conduit phases improved (time effect P < 0.05) similarly in MICT vs. HIIT (time ∗ group P > 0.54). V̇O2peak (P < 0.001) and quality of life (P < 0.001) improved equally in MICT and HIIT after CR. CONCLUSION: Early supervised exercise-based CR, whether using MICT or isovolumic HIIT, improves longitudinal myocardial function in both culprit and non-culprit territories after AMI. Exercise-based cardiac rehabilitation (CR) is an effective strategy for reducing cardiovascular morbidity and mortality in patients after a myocardial infarction (MI). While moderate-intensity continuous training (MICT) has been the traditional form of aerobic exercise in CR, high-intensity interval training (HIIT) is gaining popularity due to its demonstrated feasibility, safety, and potential superiority in improving physical fitness. The impact of CR on heart function after MI is not well understood. It is still unclear whether HIIT is more effective than MICT for improving heart function. This uncertainty is due to limitations in previous studies, such as differences in total workload realized, which is an important factor in CR. It is also unclear whether different types of exercise training have different effects on parts of the heart that were damaged due to reduced blood flow during the heart attack compared with the areas that were not affected. This study aims to fill these gaps by comparing HIIT and equal-volume MICT using advanced echocardiographic imaging techniques to evaluate overall and regional heart function, focusing on both affected and unaffected areas of the heart. We found thatExercise-based CR initiated early after the heart attack effectively improves cardiac function, with HIIT as effective as isovolumic MICT.These improvements were observed equally with both MICT and HIIT across all areas of the heart, confirming its ability to functionally recover even in regions previously impacted by reduced blood flow.
24 Apr 2026
Read appraisal →Open heart
Sex differences in risk factor control and medication adherence post-ACS: insights from the TEXTMEDS randomised clinical trial
INTRODUCTION: Poor adherence to risk factor control and life-saving medications is a key factor affecting long-term patient prognosis. Evidence indicates that sex plays a significant role in the uptake of both pharmacological and non-pharmacological interventions, ultimately influencing long-term outcomes. This study aimed to quantify sex differences in risk factor management and medication adherence following acute coronary syndrome (ACS). METHODS: This is a secondary analysis of the TEXTMEDS randomised clinical trial - a single-blind, multicentre randomised controlled trial of patients post-ACS. We compared sex differences in achieving clinical and lifestyle targets for secondary prevention, namely blood pressure control (<140/90 mm Hg), low-density lipoprotein cholesterol (LDL-C) (<1.8 mmol/L), healthy body mass index (BMI) (<25 kg/m²), regular physical activity (Global Physical Activity Questionnaire score ≥600), smoking status and adherence to cardioprotective medications (aspirin, beta blockers, ACE/angiotensin receptor blockers, statins, antiplatelets), using adjusted logistic regression models. Medication adherence was defined as taking ≥80% of prescribed doses in the month prior to follow-up, across all five drug classes, unless contraindicated. RESULTS: Of 1379 patients (mean age 58.5±10.7 years; 1095 (79.4%) male), females were less likely than men to achieve LDL-C targets (adjusted OR (aOR): 0.61, 95% CI 0.45 to 0.82) and engage in regular physical activity (aOR: 0.61, CI 0.47 to 0.80), but more likely to achieve a healthy BMI (aOR: 1.47, CI 1.04 to 2.06). Female patients are less likely to adhere to their medication compared with male counterparts (aOR: 0.68, CI 0.50 to 0.92). However, this association weakened and lost statistical significance after further adjustment for socio-economic factors (aOR: 0.71, CI 0.50 to 1.03). There were no significant interactions between sociodemographic or clinical factors and sex in relation to overall medication adherence (P-interactions >0.05). CONCLUSION: This study reveals that female patients are less likely to achieve LDL-C targets and engage in physical activity but more likely to maintain a healthy BMI. Although females showed lower medication adherence, this association weakened after adjusting for socio-economic factors. These findings highlight the importance of sex-sensitive strategies focusing on risk factor control and medication adherence for improving cardiovascular health outcomes. TRIAL REGISTRATION NUMBER: ACTRN12613000793718.
11 Apr 2026
Read appraisal →Journal of ethnopharmacology
Efficacy of Yuxintong capsule on cardiorespiratory fitness in patients with stable coronary heart disease: A multicentre, randomized, double-blind, placebo-controlled, parallel-group clinical trial
ETHNOPHARMACOLOGICAL RELEVANCE: Yuxintong capsule, a traditional Chinese patent medicine, has been widely used in the treatment of coronary heart disease (CHD). However, whether it can improve cardiopulmonary fitness (CRF) in patients with CHD remains unclear. AIM OF THE STUDY: To evaluate the efficacy and safety of Yuxintong capsule in CRF in patients with stable CHD. MATERIALS AND METHODS: A multicentre, randomized, double-blind, placebo-controlled, parallel-group trial was conducted in 13 hospitals in China from March 2021 to November 2021, and 404 patients with stable CHD were randomly assigned to receive either Yuxintong capsule and conventional Western medicine (Yuxintong group) or placebo and conventional Western medicine (placebo group) in a 1:1 ratio for 12 weeks (ChiCTR2000041293, December 23, 2020). The primary outcomes were peak oxygen uptake (VO2peak) and anaerobic threshold (AT). The secondary outcomes were metabolic equivalents (METs), duration and onset time of 1-mm ST-segment depression on electrocardiography (ECG), and 36-Item Short Form Health Survey (SF-36) scores. The main safety indicators included complete blood count, urinalysis, liver function, renal function, coagulation function, and 12-lead electrocardiogram. And adverse events were recorded throughout the trial. RESULTS: 369 patients, 187 in the Yuxintong group and 182 in the placebo group, were finally included for analysis. Compared with placebo group, 12-week treatment with Yuxintong showed an improvement in AT (0.98 ± 2.88 vs. 0.12 ± 2.79 mL kg-1·min-1; LSMD, 0.80 [95 % CI: 0.28 to 1.32]; P < 0.025), and general health (13.61 ± 15.13 vs. 8.29 ± 14.14; LSMD 5.30, [95 % CI: 2.33 to 8.31]; P < 0.05) and vitality scores (12.46 ± 11.32 vs. 6.01 ± 11.41; LSMD 6.43, [95 % CI: 4.13 to 8.31]; P < 0.05) on SF-36 scale. The other outcomes did not significantly differ between the two groups. The adverse events were similar between the two groups. CONCLUSIONS: Yuxintong capsule, as an adjunctive therapy to conventional treatment, improved AT, and general health and vitality scores on SF-36 scale in patients with stable CHD. However, the improvements in VO2peak, METs, and the duration and onset time of 1-mm ST-segment depression on ECG were not statistically significant.
6 Apr 2026
Read appraisal →European journal of cardiovascular nursing
Impact of home-based cardiac rehabilitation in people with heart failure with elevated depressive and anxiety symptoms: a secondary analysis of the REACH-HF randomized trials
AIMS: This study examined whether elevated baseline depression and anxiety moderated the effects of the REACH-HF home-based cardiac rehabilitation (CR) programme on patient outcomes in individuals with heart failure. METHODS AND RESULTS: Individual patient data from 263 patients with HF from the REACH-HF HFrEF and HFpEF trials were analysed. At baseline, 62 (24%) had elevated depression [Hospital Anxiety and Depression Scale (HADS) D > 7], and 86 (33%) had elevated anxiety (HADS-A > 7). Patients were randomized to home-based CR plus usual care or usual care alone. Outcomes at 6-12 months included depression and anxiety (HADS), health-related quality of life (HRQoL) [Minnesota Living with Heart Failure Questionnaire (MLHFQ), HeartQoL], and accelerometer-measured physical activity (PA). Linear regression models, adjusting for baseline values, stratification variables, and confounders, included interaction terms (baseline depression/anxiety ×intervention group) to assess moderation effects. Those with elevated depression showed greater benefits from CR effects in depressive symptoms and HRQoL, with significant interactions for HADS-D (P = 0.004), MLHFQ (P = 0.007), HeartQoL (P = 0.001). No effects were found for PA. In participants with elevated anxiety, significant interactions were observed for HADS-D (P = 0.024), HeartQoL physical (P = 0.04), inactivity (P = 0.02), and light PA (P = 0.04). No effects were found for anxiety symptoms or HRQoL measures. CONCLUSION: People with HF participating in REACH-HF with elevated depression and anxiety experienced greater improvements in their mental health and HRQoL than individuals without elevated symptoms. Diagnostic clinical interviews in future studies would allow for stronger conclusions regarding the impact of home-based CR on patients with confirmed depression or anxiety.
5 Apr 2026
Read appraisal →European journal of cardiovascular nursing
Effect of exercise intensity and volume on mortality and hospitalization in patients with coronary artery disease: a systematic review and pairwise and exploratory network meta-analysis
AIMS: To ascertain the impact of varying exercise intensities and volumes on clinical outcomes of patients with coronary artery disease (CAD) via a systematic review and meta-analysis. METHODS AND RESULTS: This study included randomized controlled trials to evaluate the effects of different intensity levels and volumes of exercise training and control interventions on clinical outcomes in patients with CAD. Data from eight databases were screened, extracted, and assessed for quality by two independent reviewers. Included studies were categorized into subgroups based on exercise intensity and volume. A random-effects model was used to conduct a meta-analysis of different outcomes. To further explore the combined effects, an exploratory network meta-analysis was performed, combining exercise intensity and exercise volume. Exercise training reduces the risk of cardiovascular mortality, overall hospitalization and cardiovascular hospitalization. In subgroup analyses, both moderate-intensity and continuous training significantly reduce the risk of overall hospitalization. Furthermore, the network meta-analysis shows that moderate-intensity continuous training (MICT) significantly lowers the risk of overall hospitalization [(risk ratio (RR) = 0.66, 95% confidence interval (CI): 0.47-0.95), surface under the cumulative ranking curve (SUCRA) = 70.6%] and cardiovascular hospitalization (RR = 0.66, 95% CI: 0.44-0.99, SUCRA = 80.1%) compared with usual care. In contrast to usual care, vigorous-intensity continuous training (VICT) lowers the risk of cardiovascular hospitalization (RR = 0.35, 95% CI: 0.14-0.92, SUCRA = 94.1%). CONCLUSION: MICT significantly reduces the risk of overall hospitalization and cardiovascular hospitalization. Although the evidence is limited, VICT appears to reduce the risk of cardiovascular hospitalization. Consequently, it may become an effective exercise-based intervention for preventing such events. REGISTRATION: PROSPERO: CRD42024519198.
5 Apr 2026
Read appraisal →European journal of cardiovascular nursing
Effects of personalized structured telemedicine-based exercise cardiac rehabilitation on health outcomes in patients with coronary heart disease: a systematic review and meta-analysis
AIMS: Despite its proven effectiveness, traditional exercise-based cardiac rehabilitation (exCR) suffers from low participation rates. However, telemedicine-based exCR can overcome access barriers to traditional rehabilitation while providing personalized, structured exercise training and remote monitoring. The aim of this review is to ascertain the efficacy of personalized, structured, telemedicine-based exCR in improving health outcomes in patients with coronary heart disease (CHD). METHODS AND RESULTS: A systematic search was conducted in databases including Cochrane Library, PubMed, Web of Science, Embase, CINAHL, Scopus, Medline, China National Knowledge Infrastructure, Wanfang, VIP, and SINOMED from inception to March 2024 to identify randomized controlled trials (RCTs). The final analysis included 19 RCTs comprising 2219 participants. Among patients with CHD, telemedicine-based exCR demonstrated comparable effects to centre-based exCR across multiple outcomes, including exercise capacity, physical activity levels, cardiovascular risk factors, and quality of life (all P > 0.05). Notably, when compared with usual care, telemedicine-based exCR showed significant improvements in exercise capacity [standardized mean difference (SMD) = 0.23, 95% CI: (0.12, 0.35), I2 = 34%, P < 0.0001], physical activity level [SMD = 0.32, 95% CI: (0.09, 0.54), I2 = 53%, P = 0.006], diastolic blood pressure [mean difference (MD) = -1.54, 95% CI: (-2.89, -0.20), I2 =8%, P = 0.02], body mass index [MD = -0.54, 95% CI: (-1.94, -0.14), I2 = 4%, P = 0.008], and depression [SMD = -0.27, 95% CI: (-0.42, -0.13), I2 = 33%, P = 0.0002]. CONCLUSION: Telemedicine-based exCR is equally effective as centre-based exCR in improving key health outcomes for patients with CHD, including exercise capacity, physical activity levels, cardiovascular risk factors, and quality of life. Furthermore, telemedicine-based exCR shows superior effectiveness to usual care, with statistically significant improvements in exercise capacity, physical activity, diastolic blood pressure, and depressive symptoms. REGISTRATION: PROSPERO: CRD42024521465.
5 Apr 2026
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