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Dominika Szalewska

Other affiliations: Auckland City Hospital
Bio: Dominika Szalewska is an academic researcher from Gdańsk Medical University. The author has contributed to research in topics: Telerehabilitation & Heart failure. The author has an hindex of 7, co-authored 37 publications receiving 196 citations. Previous affiliations of Dominika Szalewska include Auckland City Hospital.

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Journal ArticleDOI
TL;DR: The positive effects of a 9-week program of HCTR in patients with heart failure did not lead to the increase in percentage of days alive and out of the hospital and did not reduce mortality and hospitalization over a follow-up period of 14 to 26 months.
Abstract: Importance Guidelines recommend exercise training as a component of heart failure management. There are large disparities in access to rehabilitation, and introducing hybrid comprehensive telerehabilitation (HCTR) consisting of remote monitoring of training at patients’ homes might be an appealing alternative. Objective To assess whether potential improvements in quality-of-life outcomes after a 9-week HCTR intervention in patients with heart failure translate into improvement in clinical outcomes during extended 12 to 24 months of follow-up, compared with usual care. Design, Setting, and Participants The Telerehabilitation in Heart Failure Patients (TELEREH-HF) trial is a multicenter, prospective, open-label, parallel-group randomized clinical trial that enrolled 850 patients with heart failure up to 6 months after a cardiovascular hospitalization with New York Heart Association levels I, II, or III and left ventricular ejection fraction of 40% or less. Patients from 5 centers in Poland were randomized 1:1 to HCTR plus usual care or usual care only and followed up for 14 to 26 months after randomization. Interventions During the first 9 weeks, patients underwent either an HCTR program (1 week in hospital and 8 weeks at home) or usual care with observation. The HCTR intervention encompassed telecare, telerehabilitation, and remote monitoring of implantable devices. No intervention occurred in the remaining study period. Main Outcomes and Measures The percentage of days alive and out of the hospital from randomization through the end of follow-up at 14 to 26 months. Results A total of 850 patients were enrolled, with 425 randomized to the HCTR group (377 male patients [88.7%]; mean [SD] age, 62.6 [10.8] years) and 425 randomized to usual care (376 male patients [88.5%]; mean [SD] age, 62.2 [10.2] years). The HCTR intervention did not extend the percentage of days alive and out of the hospital. The mean (SD) days were 91.9 (19.3) days in the HCTR group vs 92.8 (18.3) days in the usual-care group, with the probability that HCTR extends days alive and out of the hospital equal to 0.49 (95% CI, 0.46-0.53;P = .74) vs usual care. During follow-up, 54 patients died in the HCTR arm and 52 in the usual-care arm, with mortality rates at 26 months of 12.5% vs 12.4%, respectively (hazard ratio, 1.03 [95% CI, 0.70-1.51]). There were also no differences in hospitalization rates (hazard ratio, 0.94 [95% CI, 0.79-1.13]). The HCTR intervention was effective at 9 weeks, significantly improving peak oxygen consumption (0.95 [95% CI, 0.65-1.26] mL/kg/min vs 0.00 [95% CI, −0.31 to 0.30] mL/kg/min;P Conclusions and Relevance In this trial, the positive effects of a 9-week program of HCTR in patients with heart failure did not lead to the increase in percentage of days alive and out of the hospital and did not reduce mortality and hospitalization over a follow-up period of 14 to 26 months. Trial Registration ClinicalTrials.gov identifier:NCT02523560

93 citations

Journal ArticleDOI
TL;DR: It is suggested that patients with ischemic left ventricular dysfunction and poor exercise capacity have increased early risk and similar 5-year mortality with CABG compared with medical therapy, whereas those with better exercisecapacity have improved survival with CabG.
Abstract: Objectives The objective of this study was to assess the prognostic significance of exercise capacity in patients with ischemic left ventricular (LV) dysfunction eligible for coronary artery bypass graft surgery (CABG). Background Poor exercise capacity is associated with mortality, but it is not known how this influences the benefits and risks of CABG compared with medical therapy. Methods In an exploratory analysis, physical activity was assessed by questionnaire and 6-min walk test in 1,212 patients before randomization to CABG (n = 610) or medical management (n = 602) in the STICH (Surgical Treatment for Ischemic Heart Failure) trial. Mortality (n = 462) was compared by treatment allocation during 56 months (interquartile range: 48 to 68 months) of follow-up for subjects able (n = 682) and unable (n = 530) to walk 300 m in 6 min and with less (Physical Ability Score [PAS] >55, n = 749) and more (PAS ≤55, n = 433) limitation by dyspnea or fatigue. Results Compared with medical therapy, mortality was lower for patients randomized to CABG who walked ≥300 m (hazard ratio [HR]: 0.77; 95% confidence interval [CI]: 0.59 to 0.99; p = 0.038) and those with a PAS >55 (HR: 0.79; 95% CI: 0.62 to 1.01; p = 0.061). Patients unable to walk 300 m or with a PAS ≤55 had higher mortality during the first 60 days with CABG (HR: 3.24; 95% CI: 1.64 to 6.83; p = 0.002) and no significant benefit from CABG during total follow-up (HR: 0.95; 95% CI: 0.75 to 1.19; p = 0.626; interaction p = 0.167). Conclusions These observations suggest that patients with ischemic left ventricular dysfunction and poor exercise capacity have increased early risk and similar 5-year mortality with CABG compared with medical therapy, whereas those with better exercise capacity have improved survival with CABG. (Comparison of Surgical and Medical Treatment for Congestive Heart Failure and Coronary Artery Disease [STICH]; NCT00023595 )

44 citations

Journal ArticleDOI
TL;DR: Implementation of a CCR program improves physical capacity, exercise tolerance, and quality of life and reduces depressive symptoms in patients late after surgical correction of CHD.
Abstract: Wstep: Waznym etapem leczenia doroslych pacjentow z wrodzonymi wadami serca po operacjach kardiochirurgicznych jest kompleksowa rehabilitacja kardiologiczna (CCR), jednak dostep do tej formy terapii jest wciąz ograniczony. Brakuje polskich wytycznych dotyczących prowadzenia CCR, w tym treningow kontrolowanych u ,,mlodych doroslych”, kilkanaście lat po zabiegu korygującym wrodzoną wade serca. Cel: Celem pracy byla ocena wplywu CCR na wydolnośc fizyczną, tolerancje wysilku, jakośc zycia i nasilenie objawow depresyjnych pacjentow w odleglym okresie po chirurgicznej korekcji wrodzonych wad serca. Metody: Do badania wlączono 57 pacjentow z wrodzonymi wadami serca (30 kobiet i 27 mezczyzn) w wieku 23 ± 3,4 roku, w okresie minimum 12 miesiecy po zabiegu zamkniecia ubytku w przegrodzie miedzykomorowej (VSD) lub ubytku w przegrodzie miedzyprzedsionkowej typu ostium secundum (ASD II). Wszystkim pacjentom zaproponowano udzial w programie CCR: 31 pacjentow wzielo udzial w programie (grupa Reh), natomiast 26 pacjentow odmowilo udzialu w programie CCR (grupa NReh). U wszystkich pacjentow wykonano wstepny test wysilkowy spiroergometryczny na cykloergometrze rowerowym, stosując protokol typu ramp o początkowym obciązeniu 20 W i przyroście obciązenia 10 W na minute. Test byl limitowany maksymalnym zmeczeniem i standardowymi wskazaniami do przerwania proby wysilkowej. Do oceny psychologicznej wykorzystano kwestionariusz Becka i test sluzący do oceny jakości zycia — Euro QoL 5D. Po 30 dniach od badania wstepnego ponownie oceniono pacjentow z obu grup, stosując takie same narzedzia badawcze jak we wstepnym badaniu. Wyniki: Podczas prob wysilkowych wszyscy pacjenci osiągneli maksymalny poziom zmeczenia na poziomie 15–17 punktow w skali Borga, bez towarzyszących powiklan. Spoczynkowy rytm serca byl nizszy w grupie Reh (74 ± 8/min) niz w grupie NReh (81 ± 14/min). Pacjenci z grupy Reh osiągneli istotnie wyzszy maksymalny rytm serca w czasie proby wysilkowej; rowniez wspolczynnik tetna maksymalnego byl wyzszy u osob trenujących. Obciązenie wysilkiem bylo nieistotnie wieksze, natomiast czas trwania wysilku znamiennie dluzszy w grupie Reh niz w grupie NReh, odpowiednio 144 W vs . 124 W (p = 0,121) oraz 14 min vs . 11 min (p = 0,001). Wyzsze szczytowe zuzycie tlenu (VO2peak) uzyskaly osoby z grupy Reh w porownaniu z pacjentami z grupy NReh (27,5 ml/kg/min vs . 23 ml/kg/min; p = 0,003). Wyzsze nasilenie objawow depresyjnych wg Becka po zakonczeniu programu stwierdzono w grupie NReh niz w grupie Reh (średnio 4,8 vs . 2,2 pkt; p = 0,59). Natomiast subiektywna i obiektywna jakośc zycia byla wyzsza w grupie Reh niz w grupie NReh, odpowiednio 89 vs . 74,4 pkt (p < 0,01) oraz 94 vs . 83 pkt (p < 0,01). Wnioski: Wdrozenie programu CCR poprawia wydolnośc fizyczną, tolerancje wysilku fizycznego, jakośc zycia i zmniejsza objawy depresyjne pacjentow w poźnym okresie po chirurgicznej korekcji wrodzonych wad serca. Wprowadzenie programu CCR wydaje sie celowe jako uzupelnienie holistycznej opieki w tej grupie pacjentow.

36 citations

Journal ArticleDOI
TL;DR: The characteristics and clinical outcomes of patients with and without DM randomized to CABG and MED or MED alone were compared in this paper, where patients with DM had more triple vessel CAD, higher LVEF, and smaller left ventricular volumes.
Abstract: The characteristics and clinical outcomes of patients with and without DM randomized to CABG and MED or MED alone were compared. DM was present in 40%. At baseline, patients with DM had more triple vessel CAD, higher LVEF, and smaller left ventricular volumes. In patients with DM, the primary outcome of all-cause mortality occurred in 39% of patients in the MED group and 39% in the CABG group [hazard ratio (HR) with CABG 0.96, 95% confidence interval (CI) 0.73–1.26]. In patients without DM, the primary outcome occurred in 41% of patients in the MED group and 32% in the CABG group (HR with CABG 0.80, 95% CI 0.63–1.02). While numerically it would appear that the treatment effect of CABG is blunted in patients with DM, there was no significant interaction between DM and treatment group on formal statistical testing.

21 citations

Journal ArticleDOI
TL;DR: In this article, the authors investigated whether an outpatient telecare based on nurse-led non-invasive assessments supporting remote therapeutic decisions (AMULET telecare) could improve clinical outcomes in patients after an episode of acute heart failure during the 12-month follow-up.
Abstract: Aim Prevention of heart failure (HF) hospitalisations and deaths constitutes a major therapeutic aim in patients with HF. The role of telemedicine in this context remains equivocal. We investigated whether an outpatient telecare based on nurse-led non-invasive assessments supporting remote therapeutic decisions (AMULET telecare) could improve clinical outcomes in patients after an episode of acute HF during the12-month follow-up. Methods and results In this prospective randomised controlled trial, patients with HF and left ventricular ejection fraction (LVEF) ≤49%, after an episode of acute HF within recent 6 months, were randomly assigned to receive either an outpatient telecare based on nurse-led non-invasive assessments (n = 300) (AMULET model) or standard care (n = 305). The primary outcome, being a composite of unplanned HF hospitalisation or cardiovascular death, occurred in 51 (17.1%) patients in the telecare group and 73 (23.9%) patients in the standard care group up to 12 months after randomization (HR: 0.69, 95% CI: 0.48-0.99, p = 0.044). The implementation of AMULET telecare, as compared to the standard care, reduced the risk of first unplanned HF hospitalisation (HR: 0.62; 95% CI: 0.42-0.91, p = 0.015) as well as the risk of total unplanned HF hospitalisations (HR: 0.64, 95% CI: 0.41-0.99, p = 0.044).There was no difference in cardiovascular mortality between the study groups (HR: 1.03, 95% CI: 0.54-1.67, p = 0.930). Conclusion AMULET telecare as compared to standard care significantly reduced the risk of HF hospitalisation or cardiovascular death during the 12-month follow-up among patients with HF and LVEF≤49% after an episode of acute HF (ClinicalTrials.gov: NCT03476590).

14 citations


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01 Jan 2014
TL;DR: These standards of care are intended to provide clinicians, patients, researchers, payors, and other interested individuals with the components of diabetes care, treatment goals, and tools to evaluate the quality of care.
Abstract: XI. STRATEGIES FOR IMPROVING DIABETES CARE D iabetes is a chronic illness that requires continuing medical care and patient self-management education to prevent acute complications and to reduce the risk of long-term complications. Diabetes care is complex and requires that many issues, beyond glycemic control, be addressed. A large body of evidence exists that supports a range of interventions to improve diabetes outcomes. These standards of care are intended to provide clinicians, patients, researchers, payors, and other interested individuals with the components of diabetes care, treatment goals, and tools to evaluate the quality of care. While individual preferences, comorbidities, and other patient factors may require modification of goals, targets that are desirable for most patients with diabetes are provided. These standards are not intended to preclude more extensive evaluation and management of the patient by other specialists as needed. For more detailed information, refer to Bode (Ed.): Medical Management of Type 1 Diabetes (1), Burant (Ed): Medical Management of Type 2 Diabetes (2), and Klingensmith (Ed): Intensive Diabetes Management (3). The recommendations included are diagnostic and therapeutic actions that are known or believed to favorably affect health outcomes of patients with diabetes. A grading system (Table 1), developed by the American Diabetes Association (ADA) and modeled after existing methods, was utilized to clarify and codify the evidence that forms the basis for the recommendations. The level of evidence that supports each recommendation is listed after each recommendation using the letters A, B, C, or E.

9,618 citations

Journal ArticleDOI
TL;DR: The second iteration of the European Society of Cardiology (ESC) and European Association for the Study of Diabetes (EASD) joining forces to write guidelines on the management of diabetes mellitus (DM), pre-diabetes, and cardiovascular disease (CVD), designed to assist clinicians and other healthcare workers to make evidence-based management decisions.
Abstract: This is the second iteration of the European Society of Cardiology (ESC) and European Association for the Study of Diabetes (EASD) joining forces to write guidelines on the management of diabetes mellitus (DM), pre-diabetes, and cardiovascular disease (CVD), designed to assist clinicians and other healthcare workers to make evidence-based management decisions. The growing awareness of the strong biological relationship between DM and CVD rightly prompted these two large organizations to collaborate to generate guidelines relevant to their joint interests, the first of which were published in 2007. Some assert that too many guidelines are being produced but, in this burgeoning field, five years in the development of both basic and clinical science is a long time and major trials have reported in this period, making it necessary to update the previous Guidelines.

2,809 citations

Journal ArticleDOI
TL;DR: This eighth edition of exercise physiology is updated with the latest research in the field to give you easy to understand up to date coverage of how nutrition energy transfer and exercise training affect human performance.

1,328 citations

Journal ArticleDOI
TL;DR: The coexistence of type 2 diabetes mellitus and heart failure (HF), either with reduced (HFrEF) or preserved ejection fraction (HFpEF), is frequent and associated with a higher risk of HF hospitalization, all‐cause and cardiovascular (CV) mortality.
Abstract: The coexistence of type 2 diabetes mellitus (T2DM) and heart failure (HF), either with reduced (HFrEF) or preserved ejection fraction (HFpEF), is frequent (30-40% of patients) and associated with a higher risk of HF hospitalization, all-cause and cardiovascular (CV) mortality. The most important causes of HF in T2DM are coronary artery disease, arterial hypertension and a direct detrimental effect of T2DM on the myocardium. T2DM is often unrecognized in HF patients, and vice versa, which emphasizes the importance of an active search for both disorders in the clinical practice. There are no specific limitations to HF treatment in T2DM. Subanalyses of trials addressing HF treatment in the general population have shown that all HF therapies are similarly effective regardless of T2DM. Concerning T2DM treatment in HF patients, most guidelines currently recommend metformin as the first-line choice. Sulphonylureas and insulin have been the traditional second- and third-line therapies although their safety in HF is equivocal. Neither glucagon-like preptide-1 (GLP-1) receptor agonists, nor dipeptidyl peptidase-4 (DPP4) inhibitors reduce the risk for HF hospitalization. Indeed, a DPP4 inhibitor, saxagliptin, has been associated with a higher risk of HF hospitalization. Thiazolidinediones (pioglitazone and rosiglitazone) are contraindicated in patients with (or at risk of) HF. In recent trials, sodium-glucose co-transporter-2 (SGLT2) inhibitors, empagliflozin and canagliflozin, have both shown a significant reduction in HF hospitalization in patients with established CV disease or at risk of CV disease. Several ongoing trials should provide an insight into the effectiveness of SGLT2 inhibitors in patients with HFrEF and HFpEF in the absence of T2DM.

389 citations