Abstract

Cardiac rehabilitation (CR) improves cardiac function and exercise capacity in patients with cardiovascular disease (CVD). Simpler techniques are needed for use by physicians in the examination room to assess the usefulness of CR. We enrolled 46 consecutive CVD patients in a CR program (CR group) and prospectively followed them for 3 months. We compared them to 18 age-, gender- and body mass index-matched CVD patients without CR (non-CR group). Various parameters were measured at baseline and after 3 months using 3 simple non-invasive tests: severity of atherosclerosis [arterial velocity pulse index and arterial pressure volume index (API)] were determined using PASESA®, an autonomic nerve total activity amount index and a coefficient of variation of the R–R interval (CVRR) were determined using eHEART®, and peripheral resistance index, pressure rate product, stroke volume and cardiac index were determined using nico®]. There were no significant differences in patient characteristics including percentages (%) of ischemic heart disease and heart failure between the non-CR and CR groups. Systolic blood pressure (SBP), diastolic BP, heart rate and API at baseline significantly decreased and CVRR at baseline significantly increased after 3 months in the CR group, but not in the non-CR group. In addition, ΔAPI (Δ = the value after 3 months minus the value at baseline) was positively associated with ΔSBP in the CR group. In conclusion, CR significantly decreased BP and improved atherosclerosis and sympathetic nerve activity. These findings suggest that simple non-invasive tests may be useful for assessing the effects of CR.

Abstract

Globally, an estimated 24 percent of the disease burden (healthy life years lost) and an estimated 23 percent of all deaths (premature mortality) are attributable to environmental risks (World Health Organization, or WHO 2006). The burden of disease is unequally shared, with the children and the poor being particularly affected. Among children between the ages 0 and 14, the proportion of deaths attributable to environmental risks, such as poor water and sanitation, indoor air pollution and vector-borne diseases, is estimated to be as high as 36 percent (WHO 2006). Several key messages have emerged from the process of putting together this study: (i) environmental health risks impose a significant burden on Nicaraguas economy, amounting to 2.6 billion Nicaraguan Cordoba (NIO) or 2.4 percent of the countrys Gross Domestic Product (GDP), and result in premature deaths and infections, especially in children under five; (ii) cost-effective interventions to address these environmental health risks exist and should be prioritized in Nicaragua; (iii) country-specific health and environmental data are somewhat limited, especially in the case of air quality, and data collection and monitoring need to be further strengthened; and (iv) the capacity of Ministry of Environment and Natural Resources (MARENA) and Ministry of Health (MINSA) staff to conduct environmental health costing analysis needs to be strengthened through proper training.