Background Limited information is available regarding the prognostic potential of muscular fitness parameters in heart failure (HF) with reduced ejection fraction (HFrEF). Hypothesis We aimed to investigate the predictive potential of knee extensor muscle strength and power on rehospitalization and evaluate the correlation between exercise capacity and muscular fitness in patients newly diagnosed with HFrEF. Methods Ninety nine patients hospitalized with a new diagnosis of HF were recruited (64 men; aged 58.7 years [standard deviation (SD), 13.2 years]; 32.3% ischemic; ejection fraction, 28% [SD, 8%]). The inclusion criteria were left ventricular ejection fraction <40% and sufficient clinical stability to undergo exercise testing. Aerobic exercise capacity was measured with cardiopulmonary exercise testing. Knee extensor maximal voluntary isometric contraction (MVIC) and muscle power (MP) were measured using the Baltimore therapeutic equipment system. The clinical outcome was HF rehospitalization. Results Over a mean follow‐up period of 1709 ± 502 days, 39 patients were rehospitalized due to HF exacerbation. HF rehospitalization was more probable for patients with diabetes and lower oxygen uptake at peak exercise (peak VO2), knee extensor MVIC, and MP. The Kaplan–Meier survival analysis revealed significantly different cumulative HF rehospitalization rates according to the tertiles of peak VO2 (P = 0.005) and MP (P = 0.002). Multivariable Cox proportional hazard model showed that the lowest tertiles of peak VO2 (hazard ratio (HR), 6.26; 95% confidence interval (CI), 1.93–20.27); and MP (HR, 5.29; 95% CI, 1.05–26.53) were associated with HF rehospitalization. Knee extensor muscle power was an independent predictor for rehospitalization in patients with HFrEF. Conclusion Knee extensor muscle power was an independent predictor for rehospitalization in patients with HFrEF.

ObjectivesTo identify the current status of smartphone usage and to describe the needs for smartphone-based cardiac telerehabilitation of cardiac patients.MethodsIn 2016, a questionnaire survey was conducted in a supervised ambulatory cardiac rehabilitation (CR) program in a university affiliated hospital with the participation of heart failure or heart transplantation patients who were smartphone users. The questionnaire included questions regarding smartphone usage, demands for smartphone-based disease education, and home health monitoring systems. Results were described and analyzed according to principal diagnosis.ResultsNinety-six patients (66% male; mean age, 53 ± 11 years), including 56 heart failure and 40 heart transplantation patients, completed the survey (completion rate, 95%). The median daily smartphone usage time was 120 minutes (interquartile range, 60–300), and the most frequently used smartphone function was text messaging (61.5%). Of the patients, 26% stated that they searched for health-related information using their smartphones more than 1 time per week. The major source of health-related information was Internet browsing (50.0%), and the least sought source was the hospital's website (3.1%). Patients with heart failure expressed significantly higher needs for disease education on treatment plan, home health monitoring of blood pressure, and body weight (χ2 = 5.79, 6.27, 4.50, p < 0.05). Heart transplantation patients expressed a significant need for home health monitoring of body temperature (χ2 = 5.25, p < 0.05).ConclusionsHeart failure and heart transplantation patients show high usage of and interest in mobile health technology. A smartphone-based cardiac telerehabilitation program should be developed based on high demand areas and modified to suit to each principal diagnosis.

This study investigated the effects of home-based exercise intensity on the aerobic capacity and 1 year re-hospitalization rate in patients with chronic heart failure (CHF). Methods: Forty seven patients with CHF (males 33, females 14, age 61.3± 9.8 years) participated in this study. The patients were allocated randomly to 3 groups in accordance with home-based exercise intensity: no home based exercise (NHE, 40%, n= 19), moderate intensity home-based exercise (MIHE, 43%, n= 20), and high intensity home based exercise (HIHE, 17%, n= 8). All patients completed the symptom-limited cardiopulmonary exercise (CPX) test safely at the cardiac rehabilitation hospital. Results: The NHE group significantly showed lower peak VO2 and a higher VE/VCO2 slope than the MIHE (p< 0.05) and HIHE (p< 0.01) groups. On the other hand, the NHE group did not show significant differences in the other hemodynamic responses, such as heart rate (HR) max, HR reserve, maximal systolic blood pressure (SBP), and SBP reserve. Nine out of 19 NHE patients (47%) were re-hospitalized related to heart disease and two out of 20 MIHE (10%) patients were re-hospitalized, but nobody in the HIHE group were re-hospitalized within 1 year from the CPX test. Conclusion: In patients with CHF, home-based self-exercise is one of the important factors for reducing the re-hospitalization rate. In addition, improved aerobic capacity is strongly associated with a lower re-hospitalization rate. In particular, re-hospitalized CHF patients showed significant differences in respiratory parameters and hemodynamic parameters compared to the non-re-hospitalized patients.

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