Malnutrition frequently coexists with heart failure (HF), leading to series of negative consequences. Cheyne–Stokes respiration (CSR) is predominantly detected in patients with HF. However, the effect of CSR and malnutrition on the long-term prognosis of patients with acute decompensated HF (ADHF) remains unclear. We enrolled 162 patients with ADHF (median age, 62 years; 78.4% men). The presence of CSR was assessed using polysomnography and the controlling nutritional status score was assessed to evaluate the nutritional status. Patients were divided into four groups based on CSR and malnutrition. The primary outcome was all-cause mortality. In total, 44% of patients had CSR and 67% of patients had malnutrition. The all-cause mortality rate was 26 (16%) during the 35.9 months median follow-up period. CSR with malnutrition was associated with lower survival rates (log-rank p < 0.001). Age, hemoglobin, albumin, lymphocyte count, total cholesterol, triglyceride, low-density lipoprotein cholesterol, creatinine, estimated glomerular filtration rate, B-type natriuretic peptide, administration of loop diuretics, apnea-hypopnea index and central apnea-hypopnea index were significantly different among all groups (p < 0.05). CSR with malnutrition was independently associated with all-cause mortality. In conclusion, CSR with malnutrition is associated with a high risk of all-cause mortality in patients with ADHF.

Background: Peak oxygen uptake (peak VO₂) and heart rate reserve (HRR) are independent prognostic markers of cardiovascular disease. However, the impact of peak VO₂ and HRR on long‐term prognosis after off‐pump coronary artery bypass grafting (OP‐CABG) remains unclear.Hypothesis: To determine the prognostic impact of peak VO₂ and HRR in patients after OP‐CABG.Results: We enrolled 327 patients (mean age, 65.1 ± 9.3 years; male, 80%) who underwent OP‐CABG and participated in early phase II cardiac rehabilitation. All participants underwent cardiopulmonary exercise testing (CPET) at the beginning of such rehabilitation. Overall, 48 (14.6%) patients died during the median follow‐up period of 103 months. The non‐survivor had significantly lower levels of peak VO₂ (10.6 ± 0.5 vs. 13.7 ± 0.2 ml/kg/min, p < .01) and HRR (24.2 ± 1.8 vs. 32.7 ± 0.8 beats/min, p < .01) than the survivor. In both groups, peak VO₂ significantly correlated with HRR (p < .01). Moreover, patients were divided into four groups according to the peak VO₂ and HRR levels for predicting total mortality. The low‐peak VO₂/low‐HRR group had a significantly higher mortality risk than the other groups (hazards ratio, 5.61; 95% confidence interval, 2.59–12.16; p < .01). After adjusted the confounding factors, peak VO₂ and HRR were independently associated with total mortality (both p < .05).Conclusions: HRR is a simple parameter of CPET and an important prognostic marker for the risk stratification of total mortality even in patients with low‐peak VO₂ after OP‐CABG.

Nutritional Status in Patients Undergoing Phase II Cardiac Rehabilitation by Mini Nutritional Assessment

Cardiac rehabilitation refers to a long-term, multifaceted, comprehensive program designed to optimize a patient’s physical, psychological, social, and vocational status. Early mobilization and rehabilitation in intensive care units have become an established position in the Japanese medical insurance system since “early rehabilitation addition (5,000 yen/patient/day, 14-day upper limit)” was newly established in the revision of medical treatment fees in FY2018. The number of older patients with heart failure continues to increase in Japan. For older patients, in addition to increasing the walking distance and confirming the safety of expanding the range of life during hospitalization, it is important to have a rehabilitation program to improve daily life functions such as being able to stand up safely and maintain good balance and stability. Although older patients with heart failure who need to improve their ability to perform activities of daily living need continuous rehabilitation after discharge from acute care hospitals, cardiac rehabilitation in rehabilitation hospitals is rarely performed due to various medical insurance systemic restrictions. In addition, only 7% of patients underwent in-patient and outpatient cardiac rehabilitation. Therefore, there are growing expectations for tele-rehabilitation using digital information and communication technology.