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Complex cardiac rehabilitation for patients following treatment for infective endocarditis - Results of the CopenHeartIE trial

Session Moderated poster session - Public health and cardiac rehabilitation

Speaker Trine Bernholdt Rasmussen

Congress : EuroHeartCare 2019

  • Topic : preventive cardiology
  • Sub-topic : Cardiovascular Rehabilitation
  • Session type : Moderated Posters
  • FP Number : 21

Authors : TB Rasmussen (Hellerup,DK), AD Zwisler (Odense,DK), SS Risom (Copenhagen,DK), KL Sibilitz (Copenhagen,DK), J Christensen (Copenhagen,DK), H Bundgaard (Copenhagen,DK), P Moons (Leuven,BE), LC Thygesen (Copenhagen,DK), JL Hansen (Copenhagen,DK), TM Norekvaal (Bergen,NO), SK Berg (Copenhagen,DK)

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Authors:
TB Rasmussen1 , AD Zwisler2 , SS Risom3 , KL Sibilitz3 , J Christensen4 , H Bundgaard3 , P Moons5 , LC Thygesen6 , JL Hansen7 , TM Norekvaal8 , SK Berg3 , 1Gentofte Hospital - Copenhagen University Hospital, Department of Cardiology - Hellerup - Denmark , 2University of Southern Denmark, REHPA - The Danish Knowledge Centre for Rehabilitation and Palliative Care - Odense - Denmark , 3Rigshospitalet - Copenhagen University Hospital, Heart Centre, Department of Cardiology - Copenhagen - Denmark , 4Rigshospitalet - Copenhagen University Hospital, Department of Occupational and Physiotherapy - Copenhagen - Denmark , 5KU Leuven, Department of Public Health and Primary Care - Leuven - Belgium , 6National Institute of Public Health, University of Southern Denmark - Copenhagen - Denmark , 7Rigshospitalet - Copenhagen University Hospital, Copenhagen Trial Unit, Centre for Clinical Intervention Research - Copenhagen - Denmark , 8Haukeland University Hospital, Department of Heart Disease - Bergen - Norway ,

On behalf: CopenHeart group

Citation:

Background: Infective endocarditis (IE) is a serious disease requiring extensive treatment and lengthy hospitalization. Despite efforts to improve treatment, outcomes post-discharge remain poor. This is the first study investigating the effects of complex cardiac rehabilitation (CCR) for this population.

Methods: A multicentre, randomised clinical trial including adults with left-sided or cardiac device endocarditis. Participants were randomised 1:1 to CCR consisting of 5 psycho-educational consultations and 12 weeks of exercise training plus usual care, or to usual care alone. Primary outcome was mental health by the Mental Component Score (MCS) on the SF-36 questionnaire at 6 months, secondary outcome was peak oxygen uptake (peak VO2) by ergo-spirometry testing at 4 months. A blinded statistician conducted all analysis using a mixed linear model and intention-to-treat analyses. Exploratory outcomes including fatigue, anxiety, depression, and additional physical tests were investigated.

Results: From 2011 to 2016, 117 patients were included. Mean age was 60 (SD=13.6) and 81% were male. No interaction between intervention and time was found for MCS (p=0.41) or peak VO2 (p=0.09). A significant effect favouring CR was seen in the exploratory outcomes general fatigue (p=0.005) and maximal power (watt) (p=0.005).

Conclusions: The provided CCR following IE had no significant effect on the primary or secondary outcomes. CCR content, duration, statistical power or lack of adherence may have influenced results. The study calls for further investigation before implementing CR on a larger scale in this high need population.

Controls CCR
N(§) Time 0 Time 1 Time 4 Time 6 Time 0 Time 1 Time 4 Time 6 P(1) P(2)
- SF-36 MCS 401 46.3 53.7 54.4 53.0 43.4 47.0 50.9 49.6 0.004 0.41
- Peak VO2 (ITT) 199 19.8 21.6 20.2 23.9 0.40 0.09
- MFI20 General fatigue 302 14.4 11.1 12.1 16.1 14.8 13.2 0.001 0.005
- HADS Depression 408 3.0 2.8 2.7 3.2 4.7 4.5 3.8 4.5 0.005 0.43
- HADS Anxiety 408 5.0 4.7 5.1 4.9 6.4 6.4 5.6 5.9 0.05 0.14
- Maximal power (watt) 199 96.4 107.4 91.6 117.8 0.77 0.005
- 6 minutes walking test 188 478.8 499.3 469.9 507.9 1.00 0.22
(ยง) No. of measurements. (1) Test for effect at time 1 (main effect of intervention in regression model) in mixed model adjusted for sex & center. (2) Interaction between intervention and time in mixed model adjusted for sex & center. ITT = Intention to Treat, MFI20 = Multidimensional Fatigue Inventory, HADS = Hospital Anxiety and Depression Scale.

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