Cardiac Rehabilitation in Patients Acutely Managed for Cardiogenic Shock (ENIGMA)

NCT06572826 | Recruiting

• 1 other identifier: ENIGMA
• Study Type: observational
• Target: 2,000
• Locations: 1 country
• Sites: 1

Brief Summary

This is a prospective and retrospective multicentre study conducted under the scientific coordination of the IRCCS Fondazione Don Gnocchi and funded by the Italian Ministry of Health (PNRR-MCNT2-2023-12377767). Using the Altshock registry, the largest multicentre Cardiogenic Shock (CS) registry in Italy, which currently has registered more than 1,000 CS patients across Italy, we will recruit patients to: (1) provide a granular assessment of post-acute phase programmes, patients' functional disability, return to work and quality of life, including specific reference to gender; (2) implement specific pathways of care in the post-acute phase; (3) provide a multidimensional assessment, thus validating an innovative model in comparison with the traditional pathway, defining the potential benefits to and impact on economic efficiency and the general sustainability of this therapeutic trajectory.

Conditions

Cardiogenic Shock

Keywords

Cardiogenic Shock; Rehabilitation

Outcome Measures

Primary Outcomes (2)

• All-cause of death

  Incidence of all-cause death

  1 Year

• Readmission in hospital for any cause

  Incidence of readmission

  1 Year

Secondary Outcomes (4)

• Severity of critical illness polyneuropathy

  6-months

• Disease-specific PROM

  6-Months

• Chronic-condition PROM

  6-months

• PREMS: patient's opinion regarding their clinical service.

  6-months

Study Arms (1)

Cardiogenic Shock

Study population: All consecutive patients with a clinical diagnosis of Cardiogenic Shock enrolled in the Altshock registry will be included.

Other: Cardiac Rehabilitation intervention

Interventions

Cardiac Rehabilitation intervention OTHER

The cardiac rehabilitation program for post-CS patients includes respiratory physiotherapy, muscle strengthening and endurance training such as walking, treadmill exercises, and cycling, all tailored to the patient's capabilities. Cardiovascular training involves interval and continuous aerobic exercises to improve heart function. The program emphasizes secondary prevention strategies, including lifestyle changes and medication management. Neuromotor rehabilitation addresses sarcopenia and polyneuropathies through targeted exercises like balance training, gait retraining, and the use of advanced technologies like functional electrical stimulation (FES), robotic devices, and virtual/augmented reality. Cognitive-behavioral therapy (CBT) helps manage the psychological effects of severe cardiovascular events. The program also includes speech and occupational therapy, planning for home reintegration, and telerehabilitation to ensure long-term recovery.

Cardiogenic Shock

Eligibility Criteria

• Age: 18 Years - 110 Years
• Sex: all
• Age Groups: Adult (18-64), Older Adult (65+)
• Sampling Method: Probability Sample

Study Population

All consecutive patients with Cardiogenic Shock (CS) will be included. The deferred consent is admitted for non-competent patients.

You may qualify if:

• All consecutive patients with a clinical diagnosis of Cardiogenic Shock.

You may not qualify if:

• Refusal to give informed consent.

Sponsors & Collaborators

• Fondazione Don Carlo Gnocchi Onlus: lead
• Ospedale Civile Ss. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy: collaborator
• Azienda Ospedaliera Brotzu: collaborator
• Azienda Ospedaliera OO.RR. S. Giovanni di Dio e Ruggi D'Aragona: collaborator
• ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy: collaborator

Study Sites (1)

Fondazione Don Gnocchi

Milan, 20148, Italy

RECRUITING

Related Publications (12)

• Rab T, Ratanapo S, Kern KB, Basir MB, McDaniel M, Meraj P, King SB 3rd, O'Neill W. Cardiac Shock Care Centers: JACC Review Topic of the Week. J Am Coll Cardiol. 2018 Oct 16;72(16):1972-1980. doi: 10.1016/j.jacc.2018.07.074.

  PMID: 30309475 RESULT

• Luscher TF, Thiele H. Cardiogenic shock: do we need a paradigm shift? Eur Heart J. 2024 Oct 14;45(39):4178-4180. doi: 10.1093/eurheartj/ehae425. No abstract available.

  PMID: 38985011 RESULT

• van Diepen S, Katz JN, Albert NM, Henry TD, Jacobs AK, Kapur NK, Kilic A, Menon V, Ohman EM, Sweitzer NK, Thiele H, Washam JB, Cohen MG; American Heart Association Council on Clinical Cardiology; Council on Cardiovascular and Stroke Nursing; Council on Quality of Care and Outcomes Research; and Mission: Lifeline. Contemporary Management of Cardiogenic Shock: A Scientific Statement From the American Heart Association. Circulation. 2017 Oct 17;136(16):e232-e268. doi: 10.1161/CIR.0000000000000525. Epub 2017 Sep 18.

  PMID: 28923988 RESULT

• Kapur NK, Kanwar M, Sinha SS, Thayer KL, Garan AR, Hernandez-Montfort J, Zhang Y, Li B, Baca P, Dieng F, Harwani NM, Abraham J, Hickey G, Nathan S, Wencker D, Hall S, Schwartzman A, Khalife W, Li S, Mahr C, Kim JH, Vorovich E, Whitehead EH, Blumer V, Burkhoff D. Criteria for Defining Stages of Cardiogenic Shock Severity. J Am Coll Cardiol. 2022 Jul 19;80(3):185-198. doi: 10.1016/j.jacc.2022.04.049.

  PMID: 35835491 RESULT

• Mueller S, Winzer EB, Duvinage A, Gevaert AB, Edelmann F, Haller B, Pieske-Kraigher E, Beckers P, Bobenko A, Hommel J, Van de Heyning CM, Esefeld K, von Korn P, Christle JW, Haykowsky MJ, Linke A, Wisloff U, Adams V, Pieske B, van Craenenbroeck EM, Halle M; OptimEx-Clin Study Group. Effect of High-Intensity Interval Training, Moderate Continuous Training, or Guideline-Based Physical Activity Advice on Peak Oxygen Consumption in Patients With Heart Failure With Preserved Ejection Fraction: A Randomized Clinical Trial. JAMA. 2021 Feb 9;325(6):542-551. doi: 10.1001/jama.2020.26812.

  PMID: 33560320 RESULT

• Molloy C, Long L, Mordi IR, Bridges C, Sagar VA, Davies EJ, Coats AJ, Dalal H, Rees K, Singh SJ, Taylor RS. Exercise-based cardiac rehabilitation for adults with heart failure. Cochrane Database Syst Rev. 2024 Mar 7;3(3):CD003331. doi: 10.1002/14651858.CD003331.pub6.

  PMID: 38451843 RESULT

• Anderson L, Oldridge N, Thompson DR, Zwisler AD, Rees K, Martin N, Taylor RS. Exercise-Based Cardiac Rehabilitation for Coronary Heart Disease: Cochrane Systematic Review and Meta-Analysis. J Am Coll Cardiol. 2016 Jan 5;67(1):1-12. doi: 10.1016/j.jacc.2015.10.044.

  PMID: 26764059 RESULT

• Balady GJ, Ades PA, Bittner VA, Franklin BA, Gordon NF, Thomas RJ, Tomaselli GF, Yancy CW; American Heart Association Science Advisory and Coordinating Committee. Referral, enrollment, and delivery of cardiac rehabilitation/secondary prevention programs at clinical centers and beyond: a presidential advisory from the American Heart Association. Circulation. 2011 Dec 20;124(25):2951-60. doi: 10.1161/CIR.0b013e31823b21e2. Epub 2011 Nov 14. No abstract available.

  PMID: 22082676 RESULT

• Yang T, Li Z, Jiang L, Wang Y, Xi X. Risk factors for intensive care unit-acquired weakness: A systematic review and meta-analysis. Acta Neurol Scand. 2018 Aug;138(2):104-114. doi: 10.1111/ane.12964. Epub 2018 May 29.

  PMID: 29845614 RESULT

• Lavie CJ, Ozemek C, Carbone S, Katzmarzyk PT, Blair SN. Sedentary Behavior, Exercise, and Cardiovascular Health. Circ Res. 2019 Mar;124(5):799-815. doi: 10.1161/CIRCRESAHA.118.312669.

  PMID: 30817262 RESULT

• Aburub A, Darabseh MZ, Badran R, Shurrab AM, Amro A, Degens H. The Application of Robotics in Cardiac Rehabilitation: A Systematic Review. Medicina (Kaunas). 2024 Jul 18;60(7):1161. doi: 10.3390/medicina60071161.

  PMID: 39064590 RESULT

• Morici N, Foglia E, Ferrario L, Pedersini P, Corda M, Ravera A, Oreni LM, Cusmano I, Garatti L, Toccafondi A, Sacco A, Oliva F, Garascia A, Frea S, Pistono M, Aschieri D, Tavazzi G, Pappalardo F. ENIGMA-shock: protocol for a study framEwork for aN InteGrated assessMent of cArdiac rehabilitation programmes in patients acutely managed for cardiogenic shock. BMJ Open. 2025 Feb 12;15(2):e092790. doi: 10.1136/bmjopen-2024-092790.

  PMID: 39938955 DERIVED

MeSH Terms

Conditions

Shock, Cardiogenic

Condition Hierarchy (Ancestors)

Myocardial Infarction; Myocardial Ischemia; Heart Diseases; Cardiovascular Diseases; Vascular Diseases; Infarction; Ischemia; Pathologic Processes; Pathological Conditions, Signs and Symptoms; Necrosis; Shock

Central Study Contacts

Nuccia Morici, MD

CONTACT

00390240308122; nmorici@dongnocchi.it

Paolo Pedersini, MSc

CONTACT

00390307245005; ppedersini@dongnocchi.it

Study Design

• Study Type: observational
• Observational Model: COHORT
• Time Perspective: OTHER
• Target Duration: 1 Year
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Study Record Dates

• First Submitted: August 21, 2024
• First Posted: August 27, 2024
• Study Start: August 31, 2024
• Primary Completion: March 31, 2026
• Study Completion (Estimated): August 31, 2026
• Last Updated: October 29, 2024

Record last verified: 2024-10

Locations

IT (1)