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Cardiac rehabilitation programs in left ventricular systolic dysfunction: do these programs reduce the number of patients requiring an implantable cardioverter defibrillator?

Session Poster Session 3

Speaker Oscar Gonzalez Fernandez

Event : Heart Failure 2016

  • Topic : arrhythmias and device therapy
  • Sub-topic : Implantable Cardioverter / Defibrillator
  • Session type : Poster Session

Authors : O Gonzalez Fernandez (Madrid,ES), P Meras Colunga (Madrid,ES), J Irazusta Cordoba (Madrid,ES), V Rial Baston (Madrid,ES), R Dalmau Gonzalez-Gallarza (Madrid,ES), C Alvarez Ortega (Madrid,ES), R Mori Junco (Madrid,ES), J Caro Codon (Madrid,ES), A Castro Conde (Madrid,ES), JL Lopez Sendon (Madrid,ES)

Authors:
O Gonzalez Fernandez1 , P Meras Colunga1 , J Irazusta Cordoba1 , V Rial Baston1 , R Dalmau Gonzalez-Gallarza1 , C Alvarez Ortega1 , R Mori Junco1 , J Caro Codon1 , A Castro Conde1 , JL Lopez Sendon1 , 1University Hospital La Paz, Cardiology - Madrid - Spain ,

Citation:
European Journal of Heart Failure Abstracts Supplement ( 2016 ) 18 ( Supplement 1 ), 377

Introduction: Cardiac rehabilitation programs(CRPs) in left ventricular systolic dysfunction(LVSD) patients(p.) provide optimal medical treatment(OMT), close monitoring, exercise and counselling. Implantable cardioverter defibrillators(ICDs) should be considered in symptomatic p. and a left ventricular ejection fraction(LVEF)≤35% despite OMT. CRPs represent a favourable scenario for a suitable stratification and optimal selection of these p.. Our purpose was to describe the population with LVEF≤35% in our program and to analyse predictors for an ICD implantation in these p.. Methods: We made an observational retrospective study including p. with LVSD admitted to a CRP between 2006 and 2015. Physical training, OMT, medical counselling and smoking cessation support, were supplied for 8 to 10 weeks. LVEF was assessed before and after the program using TTE. Functional capacity(FC) was tested before and after the CRP in accordance with the NYHA Classification, besides a treadmill stress test(TST). Exercise capacity(EC) was reported in METs. Results: A total of 206 p. were included, mean age 57.6 ± 12.3 years, male 89.8%. Baseline characteristics are shown in graphic 1. The 89.8% of these p. had a recent acute coronary syndrome. After the CRP, an ICD was implanted in 35 p.(17%). Regarding medical therapy, the number of p. receiving B-blockers, ACEi/ARB2, MRAs and ivabradine was higher after the CRP(p < 0.01). Not significant differences according to sex, age, cardiovascular risk factors(CVRF) and comorbidities were found among p. requiring or not an ICD. The use of diuretics was superior in p. requiring an ICD before(48.6% vs 20.4%; p = 0.002) and after CRP(26.5% vs 12.6%;p=0,047), no differences were found with any other treatment. The NYHA class before the program was I 44.7%, II 48%, III 6.7%, IV 0.6%. After CRP NYHA improved: I 73.2%, II 25.6%, III 1.2%(p < 0.001). Referring to TST, medium METs before CRP were 6.2 ± 2.8 and after were 9.8 ± 2.7. Mean LVEF were 29.5 ± 5.6 before and 41.8 ± 10.3 after. Patients requiring an ICD had both worst functional class before and after CRP(p = 0.005, p = 0.002; respectively), and lower LVEF before(27.6 ± 6.8 vs 30.5 ± 4.6; p = 0.02) and after CRP(30.8 ± 7.8 vs 44.8 ± 8.7; p < 0.001), as well as less METs at the beginning(5.2 ± 2.8 vs 6.6 ± 2.6; p = 0.012) and the end of the program(8.6 ± 2.9 vs 10 ± 2.7; p = 0.02). Considering p. with LVEF≤35% and NYHA II-III, differences were found before and after the program(55.3% vs 14.5%; p < 0.001), which modifies the indication for an ICD implantation along the CRP. Conclusions: CRPs are a valuable tool to properly select candidates to an ICD. CRPs improve FC, optimize medical therapy and increase LVEF. No differences in CVRF and comorbidities among p. requiring or not an ICD were found. However, these p. had less LVEF and worst FC and EC at the beginning of the CRP, besides a minor improvement of these parameters within the program. The proportion of p. with ICD indication decreases after the CRP is completed.

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