Background: Cardiac rehabilitation (CR) is effective in preventing cardiovascular diseases; however, participation in CR programs remains limited due to the associated challenges. The integration of wearable devices and real-time monitoring offers a potential solution to enhance adherence to remote CR programs and their outcomes. Objective: This study aimed to evaluate the efficacy of a remote CR program using wearable devices and real-time monitoring with or without online coaching (OLC) in improving exercise capacity in patients with coronary artery disease (CAD). Methods: We enrolled 50 patients with CAD in a remote CR program in this randomized, open-label, single-center pilot trial (phase III). After baseline cardiopulmonary exercise tests (CPETs), all patients were assigned a CPET-based home exercise program and were provided with a wearable device (Fitbit Sense; Fitbit, Inc) with a real-time monitoring system (Recoval; SapplyM, Inc). The patients were randomly assigned to an intervention group with OLC (n=25) or a control wearable device (CON; n=25) group. The primary outcomes were changes in peak oxygen consumption (peak VO₂) and anaerobic threshold VO₂ (oxygen consumption) at 12 weeks. The secondary outcomes were changes in CPET parameters, daily activity, anxiety levels, and health-related quality of life. Results: Peak VO₂ and anaerobic threshold VO₂ increased significantly from baseline to 12 weeks in the OLC (+1.6 mL/kg/min, P<.001; +1.0 mL/kg/min, P=.001) and CON (+0.6 mL/kg/min, P=.008; +1.3 mL/kg/min, P=.002) groups with no significant between-group differences (P=.65 and P=.90). In the latter half of the intervention, the daily distance and highly active time in the OLC group were significantly increased compared with those in the CON group (all P<.05). Mental status and health-related quality of life scores showed no significant differences between the groups. No major adverse cardiac events were reported. One patient in the OLC group dropped out due to lower limb muscle strain. Conclusions: Remote CR using wearable devices and a real-time monitoring system significantly improved exercise capacity in patients with CAD over a 12-week intervention program. The addition of regular OLC to the intervention program further enhanced the physical activity levels, particularly in high-intensity activities. Future studies are warranted to validate these findings in more diverse populations and over longer intervention periods to optimize the benefits and safety of remote CR programs.

The aim of this study was to investigate the long-term clinical impact of residual inflammatory risk (RIR) by evaluating serial high-sensitivity C-reactive protein (hs-CRP) in Asian patients with coronary artery disease (CAD). We evaluated 2032 patients with stable CAD undergoing percutaneous coronary intervention (PCI) with serial hs-CRP measurements (2 measurements, 6–9 months apart) from the period 2000 to 2016. A high-RIR was defined as hs-CRP > 0.9 mg/L according to the median value. Patients were assigned to four groups: persistent-high-RIR, increased-RIR, attenuated-RIR, or persistent-low-RIR. Major adverse cardiac events (MACE) and all-cause death were evaluated. MACE rates in patients with persistent high, increased and attenuated RIR were significantly higher than in patients with persistent low RIR (p < 0.001). Moreover, the rate of all-cause death was significantly higher among patients with persistent high and increased RIR than among patients with attenuated and persistent low RIR (p < 0.001). After adjustment, the presence of persistent high RIR (hazard ratio (HR) 2.22; 95% confidence interval (CI) 1.37–3.67, p = 0.001), increased RIR (HR 2.25, 95%CI 1.09–4.37, p = 0.029), and attenuated RIR (HR 1.94, 95%CI 1.14–3.32, p = 0.015) were predictive for MACE. In addition, presence of persistent high RIR (HR 2.07, 95%CI 1.41–3.08, p < 0.001) and increased RIR (HR 1.94, 95%CI 1.07–3.36, p = 0.029) were predictive for all-cause death. A high RIR was significantly associated with MACE and all-cause death among Japanese CAD patients. An evaluation of changes in inflammation may carry important prognostic information and may guide the therapeutic approach.

Background:Cerebrovascular disease often coexists with coronary artery disease (CAD), and it has been associated with worse clinical outcomes in CAD patients. However, the prognostic effect of prior stroke on long-term outcomes in patients with acute coronary syndrome (ACS) is still unclear.Methods and Results:An observational cohort study of ACS patients who underwent emergency percutaneous coronary intervention (PCI) between January 1999 and May 2015 was conducted. Patients were divided into 2 groups according to their history of stroke. We evaluated both all-cause death and cardiac death. Of the 2,548 consecutive ACS patients in the current cohort, 268 (10.5%) had a history of stroke at the onset of ACS. Patients with a history of stroke were older and had a higher prevalence of comorbidities such as hypertension or renal deficiency. The cumulative incidences of all-cause death and cardiac death were significantly higher in patients with a history of stroke (both log-rank P<0.0001). Multivariate Cox hazard regression analysis showed that a history of stroke was significantly associated with the incidences of all-cause death (hazard ratio [HR] 1.49, 95% confidence interval [CI] 1.20–1.85, P=0.0004) and cardiac death (HR 1.41, 95% CI 1.03–1.93, P=0.03).Conclusions:About 10% of the ACS patients had a history of stroke and had worse clinical outcomes.

Aims: The nutritional status and frailty are crucial in patients with aortic stenosis undergoing transcatheter aortic valve implantation (TAVI), as they significantly impact outcomes. We have previously developed an easily calculable nutritional index, TCBI (Triglycerides, total Cholesterol, and Body weight Index), which has been validated as a prognostic indicator in various cardiovascular disease contexts. This study aimed to evaluate the impact of a low TCBI on the frailty and outcomes of patients undergoing TAVI. Methods and results: This study is a part of a Japanese multi-centre prospective registry database of TAVI cases (n = 824). Participants were categorized into three groups based on TCBI tertiles before TAVI. The primary endpoint was all-cause mortality with a follow-up duration of up to 3 years. In the lowest TCBI tertile group, motor functions reflecting frailty were substantially impaired, and cumulative incidences of primary endpoint was significantly higher compared to other groups. Multivariate Cox proportional hazard analyses adjusted by risk factors for poor outcomes following TAVI identified low TCBI significantly associated with an increased risk of the primary endpoint [hazard ratio (HR) and 95% confidence interval (95% CI) of 1 SD lower TCBI for all-cause mortality: 1.52, 1.08–2.13, P = 0.015]. Moreover, in individuals who experienced serious preprocedural complications, the negative prognostic impact of low TCBI was significantly amplified (HR and 95% CI: 4.9, 1.9–12.5, P < 0.001). Conclusion: The present findings underscore the importance of nutritional assessment in patients undergoing TAVI. TCBI proved useful for accurate risk stratification and determining TAVI procedural strategies.