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Uptake and Impact of cardiac rehabilitation in heart failure after cardiac resynchronization

Session Poster Session 3

Speaker Ines Aguiar Ricardo

Event : ESC Preventive Cardiology (Formerly EuroPrevent) 2019

  • Topic : heart failure
  • Sub-topic : Chronic Heart Failure - Other
  • Session type : Poster Session

Authors : I Aguiar Ricardo (Lisbon,PT), I Goncalves (Lisbon,PT), J Agostinho (Lisbon,PT), J Rigueira (Lisbon,PT), T Rodrigues (Lisbon,PT), N Cunha (Lisbon,PT), P Antonio (Lisbon,PT), V Santos (Lisbon,PT), I Rodrigues (Lisbon,PT), R Santos (Lisbon,PT), M Carmo (Lisbon,PT), M Oliveira (Lisbon,PT), D Brito (Lisbon,PT), A Abreu (Lisbon,PT), FJ Pinto (Lisbon,PT)

Authors:
I Aguiar Ricardo1 , I Goncalves2 , J Agostinho2 , J Rigueira2 , T Rodrigues2 , N Cunha2 , P Antonio2 , V Santos3 , I Rodrigues4 , R Santos2 , M Carmo5 , M Oliveira4 , D Brito2 , A Abreu2 , FJ Pinto2 , 1University Hospital De Santa Maria, Cardiology - Lisbon - Portugal , 2Cardiology Department, Santa Maria Hospital, CHLN, CCUL, Lisbon University, Cardiology - Lisbon - Portugal , 3Faculty of Human Kinetics, Lisbon University - Lisbon - Portugal , 4Hospital de Santa Marta - Lisbon - Portugal , 5NOVA Medical School, Faculdade de Ciências Médicas - Lisbon - Portugal ,

Citation:

Introduction: Cardiac rehabilitation (CR) is an important component in the continuum of care for individuals with cardiovascular disease. Despite the formal recommendation of CR expressed in European guidelines on heart failure (HF) management, referral uptake and adherence are often suboptimal, especially in heart failure patients with devices.

Purpose: The aim of this study was to assess the uptake and impact of exercise-based CR on mortality, hospital admissions and morbidity of HF patients after CRT in real life.

Methods: Prospective observational study including consecutive HF patients (class II-IV NYHA), different etiologies, undergoing structured cardiac rehabilitation program (CRP) after cardiac resynchronizer implant. The CRP included 6 months of exercise training, aerobic and strength exercise, individually prescribed, 3 times a week, 60 minutes sessions. Clinical, electrocardiographic, and echocardiographic characteristics were evaluated prior to cardiac resynchronizer implant and all the variables were re-evaluated at 6 months after onset of CRP.

Clinical events (mortality, hospitalization, arrhythmia) were evaluated at 6 months of follow-up. Results were compared between patients who underwent CRP and those who did not perform exercise (control group).

Results: The population sample included 166 HF patients submitted to CRT (66.5% male, mean age 68±14). Of these patients, 15% performed a structured CRP after cardiac resynchronizer implant. Reasons for not performing CRP were mostly, living far away from the CR hospital centre, economic problems and professional reasons. There were 24 patients included in CRP (75% male sex, mean age 69±14), 17% in class II NYHA and 79% in class III. Etiology of heart failure was ischemic in 42% patients and dilated cardiomyopathy in 50%. Mean left ventricular ejection fraction (LVEF) at baseline was 26 ± 6%. The baseline characteristics of the control group were similar to the CR group.

At 6 months of follow-up, there was a significant improvement in LVEF (37 ± 13%, p <0.005) and in NYHA class (2,8±0.5 to 1,4±0.5; p<0.005), however comparing to the control group the difference was not significant.

During the follow-up, 1 patient died (4.2%), 7 patients (29.2%) were re-hospitalised for any cause and 1 patient (4.2%) was re-hospitalised for decompensated heart failure (group control 8.4%, 29.4%, 4.2%, respectively). The event rate was lower in the study group although not statistically significant, possibly related to the sample size.

Conclusion:
Cardiac Rehabilitation uptake was low in this population sample of heart failure patients with CRT. Clinical improvement and less cardiac events were more frequent in patients submitted to CR, although without statistical significance, probably due to the small sized group. Benefits of cardiac rehabilitation program in these patients probably are beyond the impact on ventricular remodelling, but larger studies are needed.

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