20 april 2022 – 09:50
First patients included in PRO-FIT study by Radboudumc and Máxima MC
Patients with chronic chest pain may benefit more from an exercise program than from surgery or treatment where doctors place a stent. Recent database research in patients with chronic chest pain shows strong evidence of a reduced risk of death, hospitalization and other conditions after following an exercise program. Reason enough for researchers from Radboudumc and Máxima MC to start a new study, in which they compare patients with chronic chest pain who receive a stent or undergo surgery with patients who follow cardiac rehabilitation.
Stable or chronic chest pain (angina) is usually caused by a local narrowing in one or more coronary arteries. About 450,000 Dutch people suffer from heart cramps. Due to this narrowing, the heart does not receive enough blood, which can cause the complaints of chest pain. These complaints mainly arise when the heart needs more oxygen, for example during exercise. The symptoms often have a major impact on the patient’s daily functioning. Even though these patients are well monitored and treated, they are still at risk of more serious heart failure.
Current treatment of angina pectoris
If medicines do not (or no longer) work sufficiently, an operation often follows in which doctors place a stent, for example; a hollow tube of gauze at the site of the narrowing, which prevents the narrowing from returning there. But is surgery the best treatment method for stable chest pain? Dick Thijssen, project leader of the research and professor of cardiovascular physiology at Radboudumc: “We now know that little exercise increases the risk of cardiovascular disease. People with heart problems generally move less than people without heart problems. We wanted to know whether it actually helps this group if they do follow a training program aimed at cardiac rehabilitation.”
Is the solution for the treatment of heart cramps in the lifestyle?
In a large recent study and meta-analysis, researchers Dick Thijssen, Hareld Kemps et al. compared the data of more than 18,000 patients diagnosed with stable angina pectoris. That study showed that the relative numbers of deaths, hospitalizations and new conditions are lower among patients undergoing cardiac rehabilitation than among operated patients.
However, there are no studies that directly compare the effects of lifestyle changes and surgery. The PRO-FIT research should change that. This study examines whether a lifestyle intervention after one year leads to at least as good or even better results than angioplasty treatment or bypass surgery in patients with stable angina pectoris. Or as Prof. Dr. Arnoud van ‘t Hof, head of Intervention Cardiology at the Maastricht Heart + Vascular Center puts it: “PRO-FIT is the study to show that lifestyle alone can be enough to treat your complaints of (serious) to get rid of arteriosclerosis.”
ZonMW has awarded a subsidy for this research.
Wetenschappelijke doorbraak
dr. Hareld Kemps, main applicant for the grant, cardiologist at Máxima MC and associate professor at the Industrial Design faculty of the TU/e: “This is the first large-scale randomized study investigating lifestyle interventions for these patients in this way. If the results are positive, this represents a scientific breakthrough with a major impact on the daily care of these patients. Then we can largely replace that care with a less invasive, cheaper and more sustainable treatment.”
How do we approach a lifestyle change?
The research should also provide an answer to the question of how such a lifestyle treatment can be used in healthcare practice. Thijssen: “It is a challenge to introduce lifestyle interventions nationally. This requires a change in both patients and cardiologists. Both groups have to get used to the idea that adjusting your lifestyle under the guidance of health care providers is a good or even better treatment. To maximize the chance of success, we therefore work together with Chronisch ZorgNet, a nationwide network of primary physiotherapists and remedial therapists specialized in exercise and lifestyle, patient advocacy organization Harteraad and the Dutch Cardiology Association.”
Design of the study into lifestyle and heart spasm
More than 200 patients from ten hospitals are randomly divided into two groups: one group receives the usual treatment. The other group receives a lifestyle intervention. This includes nutritional coaching and an intensive training program with a specialized physiotherapist, followed by remote guidance using an app and an activity tracker.
The research is a broad collaboration between academic hospitals Radboudumc, AMC and MUMC+, top clinical hospitals Máxima MC, Catharina Hospital, Franciscus Gasthuis & Vlietland and MSTwente, general hospitals Elkerliek hospital, Diakonessenhuis and Ikazia, universities TU/e, University of Leiden and Wageningen University , patient association Harteraad, Chronisch ZorgNet (national network of specialist care providers in exercise and lifestyle), provider of safe care communication MiBida and cardiac rehabilitation center Cardiovitaal.
The main applicant for the study is cardiologist Hareld Kemps of Máxima MC. The project management is carried out by Dick Thijssen of Radboudumc.
Bron: Maximum MC
Editorial Medicalfacts/ Janine Budding
I studied physiotherapy and health care business administration. I am also a registered Independent client supporter and informal care broker. I have a lot of experience in various positions in healthcare, the social domain and the medical, pharmaceutical industry, nationally and internationally. And have broad medical knowledge of most specialties in healthcare. And of the health care laws from which health care is regulated and financed. Every year I attend most of the leading medical conferences in Europe and America to keep my knowledge up-to-date and to keep up with the latest developments and innovations. I am currently doing a Masters in Applied Psychology.
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