Top

Published in:

Open Access 01-12-2020 | Opioids | Systematic Review

The influence of perioperative interventions targeting psychological distress on clinical outcome after total knee arthroplasty

Authors: Juliette Caroline Sorel, Geke Marianne Overvliet, Maaike Gerarda Johanna Gademan, Chantal den Haan, Adriaan Honig, Rudolf Wilhelm Poolman

Published in: Rheumatology International | Issue 12/2020

Abstract

Our aim was to assess the effect of perioperative interventions targeting psychological distress on clinical outcome after total knee arthroplasty (TKA). We searched studies on the effect of perioperative interventions focused on psychological distress used in conjunction with TKA on pain, function, and quality of life (QoL) on PubMed, Embase.com, PsycINFO/OVID, CENTRAL, the Cochrane Database of Systematic Reviews, Scopus, and Web of Science. We included 40 studies (22 RCTs, ten cohort studies, and eight quasi-experimental studies) with a total of 3846 patients. We graded the quality of evidence as low for pain and function and as moderate for QoL. Patients receiving music, education, cognitive behavioural therapy, guided imagery, pain coping skills training, Reiki, occupational therapy with self-monitoring, and biofeedback-assisted progressive muscles relaxing training had lower pain scores or declined opioid prescriptions after TKA. Pain coping skills training, audio recording-guided imagery scripts, video promoting self-confidence, psychological therapies by video, Reiki, music, occupational therapy with self-monitoring, education, and psychotherapy improved postoperative functional outcome. Education through an app improved QoL after TKA. The studies in our systematic review show that perioperative interventions targeting psychological distress for patients receiving TKA seem to have a positive effect on postoperative pain, function, and QoL. RCTs with strict methodological safeguards are still needed to determine if perioperative interventions focused on psychological distress should be used in conjunction with TKA. These studies should also assess which type of intervention will be most effective in improving patient-reported outcome measures and declining opioid prescriptions.

Available only for authorised users

Skou ST, Roos EM, Laursen MB et al (2015) A randomized, controlled trial of total knee replacement. N Engl J Med 373:1597–1606. https://doi.org/10.1056/NEJMoa1505467CrossRef

Jenkins PJ, Clement ND, Hamilton DF, Gaston P, Patton JT, Howie CR (2013) Predicting the cost-effectiveness of total hip and knee replacement: a health economic analysis. Bone Joint J 95:115–121. https://doi.org/10.1302/0301-620X.95B1.29835CrossRef

Beswick AD, Wylde V, Gooberman-Hill R, Blom A, Dieppe P (2012) What proportion of patients report long-term pain after total hip or knee replacement for osteoarthritis? A systematic review of prospective studies in unselected patients. BMJ Open. https://doi.org/10.1136/bmjopen-2011-000435CrossRefPubMed

Baker P, van der Meulen J, Lewsey J, Gregg P (2007) Nation joint registry for England and Wales. The role of pain and function in determining patient satisfaction after total knee replacement. Data from the National Joint Registry for England and Wales. J Bone Joint Surg Br 89:893–900. https://doi.org/10.1302/0301-620X.89B7.19091CrossRef

Bourne RB, Chesworth BM, Davis AM, Mahomed NN, Charron KD (2010) Patient satisfaction after total knee arthroplasty: who is satisfied and who is not? Clin Orthop Relat Red 468:57–63. https://doi.org/10.1007/s11999-009-1119-9CrossRef

Bedard NA, Pugely AJ, Westermann RW, Duchman KR, Glass NA, Callaghan JJ (2017) Opioid use after total knee arthroplasty: trends and risk factors for prolonged use. J Arthroplasty 32:2390–2394. https://doi.org/10.1016/j.arth.2017.03.014CrossRefPubMed

Volkow ND, Collins FS (2017) The Role of science in addressing the opioid crisis. N Engl J Med 377:391–394. https://doi.org/10.1056/NEJMsr1706626CrossRefPubMed

Alattas SA, Smith T, Bhatti M, Wilson-Nunn D, Donell S (2017) Greater pre-operative anxiety, pain and poorer function predict a worse outcome of a total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 25:3403–3410. https://doi.org/10.1007/s00167-016-4314-8CrossRefPubMed

Harmelink KEM, Zeegers AVCM, Hullegie W, Hoogeboom TJ, Nijhuis-van der Sanden MWG, Staal JB (2017) Are there prognostic factors for one-year outcome after total knee arthroplasty? a systematic review. J Arthroplasty 32:3840–3853. https://doi.org/10.1016/j.arth.2017.07.011CrossRefPubMed

10.

Sun K, Li H (2017) Body mass index as a predictor of outcome in total knee replace: A systemic review and meta-analysis. Knee 24:917–924. https://doi.org/10.1016/j.knee.2017.05.022CrossRefPubMed

11.

Núñez M, Núñez E, del Val JL et al (2007) Health-related quality of life in patients with osteoarthritis after total knee replacement: factors influencing outcomes at 36 months of follow-up. Osteoarthritis Cartilage 15:1001–1007. https://doi.org/10.1016/j.joca.2007.02.019CrossRefPubMed

12.

Papakostidou I, Dailiana ZH, Papapolychroniou T et al (2012) Factors affecting the quality of life after total knee arthroplasties: a prospective study. BMC Musculoskelet Discord 13:116. https://doi.org/10.1186/1471-2474-13-116CrossRef

13.

Heck DA, Robinson RL, Partridge CM, Lubitz RM, Freund DA (1998) Patient outcomes after knee replacement. Clin Orthop Relat Res 356:93–110. https://doi.org/10.1097/00003086-199811000-00015CrossRef

14.

Lingard EA, Katz JN, Wright EA, Sledge CB (2004) Kinemax Outcomes Group. Predicting the outcome of total knee arthroplasty. J Bone Joint Surg Am 86:2179–2186. https://doi.org/10.2106/00004623-200410000-00008CrossRefPubMed

15.

Roth JS, Buehler KC, Shen J, Naughton M (2013) Patient factors predict functional outcomes after cruciate retaining TKA: a 2-year follow-up analysis. J Arthroplasty 28:1321–1326. https://doi.org/10.1016/j.arth.2013.01.009CrossRefPubMed

16.

Khatib Y, Madan A, Naylor JM, Harris IA (2015) Do psychological factors predict poor outcome in patients undergoing TKA? A systematic review. Clin Orthop Relat Res 473:2630–2638. https://doi.org/10.1007/s11999-015-4234-9CrossRefPubMed

17.

Burns LC, Ritvo SE, Ferguson MK, Clarke H, Seltzer Z, Katz J (2015) Pain catastrophizing as a risk factor for chronic pain after total knee arthroplasty: a systematic review. J Pain Res 8:21–32. https://doi.org/10.2147/JPR.S64730CrossRefPubMed

18.

Hernández C, Díaz-Heredia J, Berraquero ML, Crespo P, Loza E, Ruiz Ibán MÁ (2015) Pre-operative predictive factors of post-operative pain in patients with hip or knee arthroplasty: a systematic review. Reumatol Clin 11:361–380. https://doi.org/10.1016/j.reuma.2014.12.008CrossRefPubMed

19.

Lewis GN, Rice DA, McNair PJ, Kluger M (2015) Predictors of persistent pain after total knee arthroplasty: systematic review and meta-analysis. Br J Anaesth 114:551–561. https://doi.org/10.1093/bja/aeu441CrossRefPubMed

20.

Sorel JC, Veltman ES, Honig A, Poolman RW (2019) The influence of preoperative psychological distress on pain and function after total knee arthroplasty: a systematic review and meta-analysis. Bone Joint J. https://doi.org/10.1302/0301-620X.101B1.BJJ-2018-0672.R1CrossRefPubMed

21.

Clarke HD, Timm VL, Goldberg BR, Hattrup SJ (2012) Preoperative patient education reduces in-hospital falls after total knee arthroplasty. Clin Orthop Relat Res 470:244–249. https://doi.org/10.1007/s11999-011-1951-6CrossRefPubMed

22.

Gordon D, Malhas A, Goubran A, Subramanian P, Messer C, Houlihan-Burne D (2011) Implementing the rapid recovery program in primary hip and knee arthroplasty in a UK state run hospital. Eur J Orthop Surg Traumatol 21:151–158. https://doi.org/10.1007/s00590-010-0690-9CrossRef

23.

Tristaino V, Lantieri F, Tornago S, Gramazio M, Carriere E, Camera A (2016) Effectiveness of psychological support in patients undergoing primary total hip or knee arthroplasty: a controlled cohort study. J Orthopaed Traumatol 17:137–147. https://doi.org/10.1007/s10195-015-0368-5CrossRef

24.

White L, Stockwell T, Hartnell N, Henessy M, Mullan J (2016) Factors preventing kneeling in a group of pre-educated patients post total knee arthroplasty. J Orthopaed Traumatol 17:333–338. https://doi.org/10.1007/s10195-016-0411-1CrossRef

25.

Bay S, Kuster L, McLean N, Byrnes M, Kuster MS (2018) A systematic review of psychological interventions in total hip and knee arthroplasty. BMC Musculoskeletal Disorders 19:201. https://doi.org/10.1186/s12891-018-2121-8CrossRefPubMed

26.

Szeverenyi C, Kekecs Z, Johnson A, Elkins G, Csernatony Z, Varga K (2018) The use of adjunct psychosocial interventions can decrease postoperative pain and improve the quality of clinical care in orthopedic surgery: A systematic review and meta-analysis of randomized controlled trials. J Pain 19(11):1231–1252. https://doi.org/10.1016/j.jpain.2018.05.006CrossRefPubMed

27.

Tong F, Dannaway J, Enke O, Eslick G (2020) Effect of preoperative psychological interventions on elective orthopaedic surgery outcomes: a systematic review and meta-analysis. ANZ J Surg 90(3):230–236. https://doi.org/10.1111/ans.15332CrossRefPubMed

28.

Moher D, Liberati A, Tetzlaff J, Altman DG, The PRISMA Group (2009) Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement. BMJ 339:b2535. https://doi.org/10.1371/journal.pmed.1000097CrossRefPubMed

29.

Gasparyan AY, Ayvazyan L, Blackmore H, Kitas GD (2011) Writing a narrative biomedical review: considerations for authors, peer reviewers, and editors. Rheumatol Int 31(11):1409–1417. https://doi.org/10.1007/s00296-011-1999-3CrossRef

30.

Higgins JPT, Altman DG, Sterne JAC (editors). Chapter 8: Assessing risk of bias in included studies. In: Higgins JPT, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 (updated March 2011). The Cochrane Collaboration, 2011. Available from www.handbook.cochrane.org

31.

Guyatt G, Oxman AD, Aki EA et al (2011) GRADE guidelines: 1. Introduction-GRADE evidence profiles and summary of findings tables. J Clin Epidemiol 64:383–394. https://doi.org/10.1016/j.jclinepi.2010.04.026CrossRef

32.

Allred KD, Byers JF, Sole ML (2010) The effect of music on postoperative pain and anxiety. Pain Manag Nurs 11:15–25. https://doi.org/10.1016/j.pmn.2008.12.002CrossRef

33.

Aris A, Sulaiman S, Che Hasan MK (2019) The influence of music therapy on mental well-being among postoperative patients of total knee arthroplasty (TKA). Enferm Clin 29(2):16–23. https://doi.org/10.1016/j.enfcli.2019.04.004CrossRef

34.

Chen HJ, Chen TY, Huang CY, Hsieh YM, Lai HL (2015) Effects of music on psychophysiological responses and opioid dosage in patients undergoing total knee replacement surgery. Jpn J Nurs Sci 12:309–319. https://doi.org/10.1111/jjns.12070CrossRef

35.

Hsu CC, Chen WM, Chen SR, Tseng YT, Lin PC (2016) Effectiveness of music listening in patients with total knee replacement during CPM rehabilitation. Biol Res Nurs 18:68–75. https://doi.org/10.1177/1099800415572147CrossRef

36.

Hsu CC, Chen SR, Lee PH, Lin PC (2019) The effect of music listening on pain, heart rate variability, and range of motion in older adults after total knee replacement. Clin Nurs Res 28(5):529–547. https://doi.org/10.1177/1054773817749108CrossRef

37.

Keshmiri A, Wolf T, Wiech O, Benditz A, Grifka J, Springorum H (2014) Einfluss der intraoperativen Schallprotektion auf postoperative Schmerzen. Schmerz 28:82–89. https://doi.org/10.1007/s00482-013-1368-0CrossRef

38.

Leonard H (2019) Live music therapy during rehabilitation after total knee arthroplasty: a randomized controlled trial. J Music Ther 56:61–89. https://doi.org/10.1093/jmt/thy022CrossRef

39.

Santhna LP, Norhamdan MY, Damrudi M (2015) The effectiveness of music therapy for post-operative pain control among total knee replacement patients. Med & Health 10(1):66–79

40.

Simcock XC, Yoon RS, Chalmers P, Geller JA, Kiernan HA, Macaulay W (2008) Intraoperative music reduces perceived pain after total knee arthroplasty: a blinded, prospective, randomized, placebo-controlled clinical trial. J Knee Surg 21:275–278. https://doi.org/10.1055/s-0030-1247831CrossRefPubMed

41.

Atabaki S, Farahani MA, Haghani S (2019) Effect of rehabilitation education on pain, knee stiffness and performance difficulty in patients undergoing knee replacement surgery: A randomized clinical trial. J Acute Dis 8(6):233–238. https://doi.org/10.4103/2221-6189.272854CrossRef

42.

Aytekin E, Sukur E, Oz N et al (2019) The effect of a 12 week prehabilitation program on pain and function for patients undergoing total knee arthroplasty: A prospective controlled study. J Clin Orthop Trauma 10:345–349. https://doi.org/10.1016/j.jcot.2018.04.006CrossRefPubMed

43.

Chen SR, Chen CS, Lin PC (2014) The effect of educational intervention on the pain and rehabilitation performance of patients who undergo a total knee replacement. J Clin Nurs 23:279–287. https://doi.org/10.1111/jocn.12466CrossRefPubMed

44.

Huang S-W, Chen P-H, Chou Y-H (2012) Effects of a preoperative simplified home rehabilitation education program on length of stay of total knee arthroplasty patients. Orthop Traumat Surgery Res 98:259–264. https://doi.org/10.1016/j.otsr.2011.12.004CrossRef

45.

Huang P, He J, Zhang YM (2017) The mobile application of patient management in education and follow-up for patients following total knee arthroplasty. Zhonghua Yi Xue Za Zhi 97:1592–1595. https://doi.org/10.3760/cma.j.issn.0376-2491.2017.20.019CrossRefPubMed

46.

Lee JK, Zubaidah JO, Fadhilah ISI, Normala I, Jensen MP (2019) Prerecorded hypnotic peri-surgical intervention to alleviate risk of chronic postsurgical pain in total knee replacement: a randomized controlled pilot study. Int J Clin Exp Hypn 67:217–245. https://doi.org/10.1080/00207144.2019.1580975CrossRefPubMed

47.

Lin PC, Lin LC, Lin JJ (1997) Comparing the effectiveness of different educational programs for patients with total knee arthroplasty. Orthop Nurs 16(5):43–49CrossRefPubMed

48.

Louw A, Puentedura EJ, Reed J, Zimney K, Grimm D, Landers MR (2019) A controlled clinical trial of preoperative pain neuroscience education for patients about to undergo total knee arthroplasty. Clin Rehabil 33(11):1722–1731. https://doi.org/10.1177/0269215519857782CrossRefPubMed

49.

Malletschek A, Tiller D, Wohlrab D (2020) Psychoedukation bei Patienten mit Knieendoprothese : Erweitertes Schmerzmanagement [Psychoeducation in knee arthroplasty patients : Additional pain management]. Orthopade 49(1):26–31. https://doi.org/10.1007/s00132-019-03749-yCrossRefPubMed

50.

Moulton LS, Evans PA, Starks I, Smith T (2017) Preoperative education prior to elective knee arthroplasty surgery does not change patient outcomes. Musculoskeletal Care 15:341–344. https://doi.org/10.1002/msc.1177CrossRefPubMed

51.

Piva SR, Almeida GJ, Gil AB, DiGioia AM, Helsel DL, Sowa GA (2017) Effect of comprehensive behavioral and exercise intervention on physical function and activity participation after total knee replacement: a pilot randomized study. Arthritis Care Res (Hoboken) 69(12):1855–1862. https://doi.org/10.1002/acr.23227CrossRef

52.

Reslan HA, Moustafa SM, Saghieh S, Sharaza ES, Badr LK (2018) Does intervention improve the outcomes of patients after total knee replacement surgery? Int J Ortho Trauma Nurs 31:26–31. https://doi.org/10.1016/j.ijotn.2018.08.001CrossRef

53.

Timmers T, Janssen L, van der Weegen W, Das D, Marijnissen WJ, Hannink G, van der Zwaard BC, Plat A, Thomassen B, Swen JW, Kool RB, Lambers Heerspink FO (2019) the effect of an app for day-to-day postoperative care education on patients with total knee replacement: randomized controlled trial. JMIR Mhealth Uhealth 7(10):e15323. https://doi.org/10.2196/15323CrossRefPubMed

54.

Wilson RA, Watt-Watson J, Hodnett E, Tranmer J (2016) A randomized controlled trial of an individualized preoperative education intervention for symptom management after total knee arthroplasty. Orthop Nurs 35:20–29. https://doi.org/10.1097/NOR.0000000000000210CrossRefPubMed

55.

Yajnik M, Hill JN, Hunter OO et al (2019) Patient education and engagement in postoperative pain management decreases opioid use following knee replacement surgery. Patient Educ Couns 102:383–387. https://doi.org/10.1016/j.pec.2018.09.001CrossRefPubMed

56.

Birch S, Stilling M, Mechlenburg I, Hansen TB (2020) No effect of cognitive behavioral patient education for patients with pain catastrophizing before total knee arthroplasty: a randomized controlled trial. Acta Orthop. 91(1):98–103. https://doi.org/10.1080/17453674.2019.1694312CrossRefPubMed

57.

Cai LB, Liu YJ, Zhao H, Xu HP, Gao HH, Dong YZ (2017) Cognitive behavior therapy alleviates kinesiophobia after total knee arthroplasty. Zhongguo Zuzhi Gongcheng Yanjiu 21:3658–3663

58.

Cai L, Gao H, Xu H, Wang Y, Lyu P, Liu Y (2018) Does a program based on cognitive behavioral therapy affect kinesiophobia in patients following total knee arthroplasty? a randomized, controlled trial with a 6-month follow-up. J Arthroplasty 33:704–710. https://doi.org/10.1016/j.arth.2017.10.035CrossRefPubMed

59.

Das Nair R, Mhizha-Murira JR, Anderson P et al (2018) Home-based pre-surgical psychological intervention for knee osteoarthritis (HAPPiKNEES): a feasibility randomized controlled trial. Clin Rehabil 32:777–789. https://doi.org/10.1177/0269215518755426CrossRefPubMed

60.

Harnirattisai T, Johnson RA (2005) Effectiveness of a behavioral change intervention in Thai elders after knee replacement. Nurs Res 54:97–107. https://doi.org/10.1097/00006199-200503000-00004CrossRefPubMed

61.

Jacobson AF, Umberger WA, Palmieri PA, Alexander TS, Myerscough RP, Draucker CB, Steudte-Schmiedgen S, Kirschbaum C (2016) Guided imagery for total knee replacement: a randomized, placebo-controlled pilot study. J Altern Complement Med 22:563–575. https://doi.org/10.1089/acm.2016.0038CrossRefPubMed

62.

Riddle DL, Keefe FJ, Nay WT, McKee D, Attarian DE, Jensen MP (2011) Pain coping skills training for patients with elevated pain catastrophizing who are scheduled for knee arthroplasty: a quasi-experimental study. Arch Phys Med Rehabil 92:859–865. https://doi.org/10.1016/j.apmr.2011.01.003CrossRefPubMed

63.

Riddle DL, Keefe FJ, Ang DC et al (2019) Pain coping skills training for patients who catastrophize about pain prior to knee arthroplasty: a multisite randomized clinical trial. J Bone Joint Surg Am 6(101):218–227. https://doi.org/10.2106/JBJS.18.00621CrossRef

64.

Russo LR, Benedetti MG, Mariani E, Roberti di Sarsina T, Zaffagnini S (2017) The videoinsight^® method: improving early results following total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 25:2967–2971. https://doi.org/10.1007/s00167-016-4118-xCrossRefPubMed

65.

Zaffagnini S, Russo LR, Marcheggiani Muccioli GM, Marcacci M (2013) The Videoinsight^® method: improving rehabilitation following anterior cruciate ligament reconstruction—a preliminary study. Knee Surg Sports Traumatol Arthrosc 21:851–858. https://doi.org/10.1007/s00167-013-2392-4CrossRefPubMed

66.

Baldwin AL, Vitale A, Brownell E, Kryak E, Rand W (2017) Effects of reiki on pain, anxiety, and blood pressure in patients undergoing knee replacement: a pilot study. Holist Nurs Pract 31:80–89. https://doi.org/10.1097/HNP.0000000000000195CrossRefPubMed

67.

Christiansen CL, Bade MJ, Davidson BJ, Dayton MR, Stevens-Lapsley JE (2015) Effects of weight-bearing biofeedback training on functional movement patterns following total knee arthroplasty: a randomized controlled trial. J Orthop Sports Phys Ther 45:647–655. https://doi.org/10.2519/jospt.2015.5593CrossRefPubMed

68.

Hiraga Y, Hisano S, Nomiyama K, Hirakawa Y (2019) Effects of using activity diary for goal setting in occupational therapy on reducing pain and improving psychological and physical performance in patients after total knee arthroplasty: A non-randomised controlled study. Hong Kong J Occup Ther. 32(1):53–61. https://doi.org/10.1177/1569186119849117CrossRefPubMed

69.

Koo K, Park DK, Youm YS, Cho SD, Hwang CH (2018) Enhanced reality showing long-lasting analgesia after total knee arthroplasty: prospective. Random Clin Trial Sci Rep 8:2343. https://doi.org/10.1038/s41598-018-20260-0CrossRef

70.

Notte BB, Fazzine C, Mooney RA (2016) Reiki's effect on patients with total knee arthroplasty: A pilot study. Nursing 46:17–23. https://doi.org/10.1097/01.NURSE.0000476246.16717.65CrossRef

71.

Wang TJ, Chang CF, Lou MF et al (2015) Biofeedback relaxation for pain associated with continuous passive motion in Taiwanese patients after total knee arthroplasty. Res Nurs Health 38:39–50. https://doi.org/10.1002/nur.21633CrossRef

72.

Shim J, Hamilton DF (2019) Comparative responsiveness of the PROMIS-10 Global Health and EQ-5D questionnaires in patients undergoing total knee arthroplasty. Bone Joint J 101-B:832–837. https://doi.org/10.1302/0301-620X.101B7.BJJ-2018-1543.R1CrossRefPubMed

Title: The influence of perioperative interventions targeting psychological distress on clinical outcome after total knee arthroplasty
Authors: Juliette Caroline Sorel
Geke Marianne Overvliet
Maaike Gerarda Johanna Gademan
Chantal den Haan
Adriaan Honig
Rudolf Wilhelm Poolman
Publication date: 01-12-2020
Publisher: Springer Berlin Heidelberg
Keywords: Opioids
Opioids
Published in: Rheumatology International / Issue 12/2020
Print ISSN: 0172-8172
Electronic ISSN: 1437-160X
DOI: https://doi.org/10.1007/s00296-020-04644-y

Obesity Clinical Trial Summary

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine

Highlights from the ACC 2024 Congress

Year in Review: Pediatric cardiology

Pediatric Cardiology Video

Watch Dr. Anne Marie Valente present the last year's highlights in pediatric and congenital heart disease in the official ACC.24 Year in Review session.

Year in Review: Pulmonary vascular disease

Cardiopulmonary Comorbidity Video

The last year's highlights in pulmonary vascular disease are presented by Dr. Jane Leopold in this official video from ACC.24.

Year in Review: Valvular heart disease

Valvular Heart Disease Video

Watch Prof. William Zoghbi present the last year's highlights in valvular heart disease from the official ACC.24 Year in Review session.

Year in Review: Heart failure and cardiomyopathies

Heart Failure Video

Watch this official video from ACC.24. Dr. Biykem Bozkurt discuss last year's major advances in heart failure and cardiomyopathies.

ACC 2024 Congress Coverage

Heart Failure Video

Year in Review: Heart failure and cardiomyopathies

Watch now

Watch this official video from ACC.24. Dr. Biykem Bozkurt discuss last year's major advances in heart failure and cardiomyopathies.

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

16-04-2024 Type 2 Diabetes News

Incentivised to exercise

11-04-2024 Lifestyle Modifications News

New intervention for STEMI-related cardiogenic shock

10-04-2024 Myocardial Infarction News

» View more highlights on the ACC 2024 congress hub page

Image Credits

STEP AAG HeroTeaserCollection image/© Tarek / Generated with AI / Stock.adobe.com, ACC 2024 Pediatric and Congenital Heart Disease: Year in Review/© 2024 American College of Cardiology, ACC 2024 Pulmonary Vascular Disease: Year in Review/© 2024 American College of Cardiology, ACC 2024 Valvular Heart Disease: Year in Review/© 2024 American College of Cardiology, ACC 2024 HF and Cardiomyopathies: Year in Review/© 2024 American College of Cardiology, Woman out walking/© Seventyfour / stock.adobe.com (symbolic image with model), Woman checking smartwatch /© saltdium / stock.adobe.com (symbolic image with model), Cardiac catheterization/© Damian / stock.adobe.com

At a glance: The STEP trials

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Issue 12/2020

Utility of the neutrophil-to-lymphocyte ratio for predicting bacterial infection in patients with rheumatoid arthritis receiving Tocilizumab

#Covid4Rheum: an analytical twitter study in the time of the COVID-19 pandemic

Osteoporosis in patients with rheumatoid arthritis: trends in the German National Database 2007–2017

Familial aggregation of longevity in giant cell arteritis and polymyalgia rheumatica

Comparing quality and readability of online English language information to patient use and perspectives for common rheumatologic conditions

Adaptation and validation of the Rheumatoid Arthritis Quality of Life (RAQoL) questionnaire for use in Bulgaria

Highlights from the ACC 2024 Congress

ACC 2024 Congress Coverage