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Moderate exercise was safe in hypertrophic cardiomyopathy, with a "statistically significant but small increase in exercise capacity at 16 weeks," the 136-patient randomized RESET-HCM trial showed.
A program of unsupervised exercise -- cycling, walk-jog combinations, or elliptical training -- individualized to heart rate reserve for 16 weeks improved exercise capacity compared with usual activity (+1.35 vs +0.08 mean peak oxygen consumption, P=0.02), without any cases of sustained ventricular arrhythmia, sudden cardiac arrest, appropriate defibrillator shock, or death in either group.
"Further research is needed to understand the clinical importance of this finding in patients with hypertrophic cardiomyopathy, as well as the long-term safety of exercise at moderate and higher levels of intensity," they concluded online in the JAMA Cardiology.
An accompanying editorial agreed: "Defining a safe level of exercise for patients with hypertrophic cardiomyopathy is still a work in progress. However, the suggestion of efficacy is significant."
Bystander Defibrillation
Out-of-hospital cardiac arrest survival rates improved after a nationwide initiative in Denmark that boosted bystander response in the community, researchers reported online in JAMA Cardiology.
The initiative included resuscitation training, getting more automated external defibrillators (AEDs) into the community, a registry linking them to emergency medical dispatch centers, and dispatcher guidance for bystanders' resuscitation efforts gradually introduced from 2007 through 2012.
Comparing before the intervention (2001) to 2012, bystanders delivered defibrillation more often in the public locations where most AEDs had been installed. The rate increased significantly from 1.2% of public-location cardiac arrests to 15.3%. However, the greatest number of arrests occurred in residential locations, and bystander defibrillation rates did not improve there (1.3% at both time points).
Overall, those who did get bystander defibrillation had better 30-day survival over time. In public location cases, the rate improved from from 8.3% in 2001/2002 to 57.5% in 2011/2012 (P<0.001). In residential location cases, it improved from 0.0% to 25.6% over the same time frame (P<0.001).
"These data illustrate a successful transformation of the public setting into an environment conducive to rapid layperson action, including AED use," an accompanying editorial noted. "However, the data also illustrate how massive efforts have a smaller effect on rescue in private settings."
"Data such as those provided by Hansen et al can help focus and maximize the return on these large investments by showing us when and where we actually transform bystanders into rescuers," it concluded.
Failed Fertility Tx
Women who don't get pregnant after fertility therapy were at 21% higher risk of any cardiovascular event over about 8 years than those for whom the treatments work, a population-based cohort study reported in the Canadian Medical Association Journal.
The risk was more than doubled for heart failure but also significant for ischemic strokes.
"These findings are consistent with the hypothesis that fertility therapy may represent an early indication for future cardiovascular disease because it represents a unique cardiometabolic stress test," the researchers wrote. "These women merit surveillance for subsequent cardiovascular events."
"We don't want to alarm women who undergo fertility therapy; we are instead suggesting that as women age, they should stay mindful of their health and remind their physician about any fertility therapy years earlier," author Donald Redelmeier, MD, of the University of Toronto, said in a press release. "It can be an opportunity for their doctor to review other risk factors for heart disease and discuss ways to protect against future cardiac problems."
See the full MedPage Today story here.
In Other News
An early experience with the relatively few patients who have been treated for ischemic stroke while on a non-vitamin K oral anticoagulant (NOAC) suggested that thrombolysis "appears to be reasonably well tolerated without prohibitive risks for adverse events among selected NOAC-treated patients," researchers reported in Circulation.