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Background: Heart failure (HF), is a leading cause of cardiovascular morbidity and mortality in Sub-Saharan Africa. Cardiac rehabilitation (CR) is known to improve functional capacity and reduce morbidity associated with HF. Although CR is a low-cost intervention, global access and adherence rates to CR remain poor. In regions such as Western Kenya, CR programs do not exist. We sought to establish the feasibility CR for HF in this region by testing adherence to institution and home-based models of CR. Methods: One hundred participants with New York Heart Association (NYHA) class II and III HF symptoms were prospectively enrolled from a tertiary health facility in Western Kenya. Participants were non-randomly assigned to participate in one of two CR models based on their preference. Institution based cardiac rehabilitation (IBCR) comprised 36 facility-based exercise sessions over a period of 12 weeks. Home based cardiac rehabilitation (HBCR) comprised weekly pedometer guided exercise targets over a period of 12 weeks. An observational arm (OA) receiving usual care was also enrolled. The primary endpoint of CR feasibility was assessed based on study participants to adherence to at least 25% of exercise sessions. Secondary outcomes of change in NYHA symptom class, and six-minute walk time distance (6MWTD) were also evaluated. Data were summarized and analyzed as means (SD) and frequencies. Paired t-tests, Chi Square, Fisher’s, and ANOVA tests were used for comparisons. Findings: Mean protocol adherence was greater than 25% in both CR models; 46% ± 18 and 29% ± 11 (P < 0.05) among IBCR and HBCR participants respectively. Improvements by at least one NYHA class were observed among 71%, 41%, and 54%, of IBCR, HBCR and OA participants respectively. 6MWTD increased significantly by a mean of 31 ± 65 m, 40 ± 55 m and 38 ± 71 m in the IBCR, HBCR and OA respectively (P < 0.05). Conclusions: IBCR and HBCR, are feasible rehabilitation models for HF in Western Kenya. Whereas improvement in functional capacity was observed, effectiveness of CR in this population remains unknown. Future randomized studies evaluating effect size, long term efficacy, and safety of cardiac rehabilitation in low resource settings such as Kenya are recommended.

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Background: Heart failure (HF) is a growing driver of morbidity and mortality worldwide. Cardiac rehabilitation in HF improves functional status, quality of life, and depression. Global access to cardiac rehabilitation remains poor, and adherence rates are low. Methods: We implemented and assessed adherence rates associated with two models of cardiac rehabilitation in Western Kenya. One hundred participants with HF were prospectively enrolled. Choice of rehabilitation model was based on participant preference. Twenty-five participants opted to participate in 36 institution-based sessions (IBCR). Thirty-one participants enrolled into home-based sessions (HBCR). HBCR comprised 12 weekly pedometer step targets. Forty-four participants were later enrolled into an observational arm (OA). We hypothesized that participants would adhere to at least 25% of prescribed sessions. We secondarily compared changes in 6-minute walk time distance (6MWTD), depression screening (PHQ9) and quality of life (SF36) scores using a paired t-test. Results: The mean age of participants was 51 years, of whom 73 were female. Rehabilitation participants preferred institution based rehabilitation. Both study arms were adherent to the prescribed protocol as shown in figure 1. All study arms demonstrated significant improvement in 6MWTD, PHQ9 and SF36 scores. Conclusions: IBCR and HBCR, are feasible rehabilitation models for HF in this setting. Adherence rates attained in both models are higher than those seen in many developed countries. Although our results demonstrate feasibility, future research should focus on methods to further improve adherence as well evaluate efficacy of cardiac rehabilitation in this setting.