Cardiac Rehabilitation Improves Functional Capacity and Patient-Reported Health Status in Patients With Continuous-Flow Left Ventricular Assist Devices

Kerrigan, Dennis J.; Williams, C.; Ehrman, Jonathan K.; Saval, Matthew A.; Bronsteen, Kyle; Schairer, John R.; Swaffer, Meghan; Brawner, Clinton A.; Lanfear, David E.; Selektor, Yelena; Velez, Mauricio; Tita, Cristina; Keteyian, Steven J.

doi:10.1016/j.jchf.2014.06.011

Cited by 129 publications

(115 citation statements)

References 22 publications

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“…Despite this increased clinical exposure, there remains a lack of familiarity with the care of patients with LVADs in acute and SAR centers. The safety and efficacy of postoperative physical, occupational, and speech therapy has been evaluated and confirmed in patients with LVADs [13,14]. The importance of rehabilitation and exercise in these patients in the reversal of progressive deconditioning as a result of chronic heart failure is well understood and has been shown to improve clinical outcomes, including survival and quality of life [15,16].…”

Section: Discussionmentioning

confidence: 99%

Efficacy of Inpatient Rehabilitation After Left Ventricular Assist Device Implantation

Yost

Coyle

Milkevitch

et al. 2016

PM&R

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Section: Discussionmentioning

confidence: 99%

Efficacy of Inpatient Rehabilitation After Left Ventricular Assist Device Implantation

Yost

Coyle

Milkevitch

et al. 2016

PM&R

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“…Cardiac rehabilitation (CR) can and should make an important contribution in this context (3,4). After being discharged from a CR center the patients should once more become able to autonomously manage the necessary tasks in their everyday lives back home.Over the last few years, several studies have emerged, most of them small, which report results following rehabilitation (5)(6)(7)(8)(9)(10)(11)(12)(13)(14). In these studies, physical performance at the end of CR was evaluated using different measuring techniques (functional independence measures [FIM], treadmill ergometry, bicycle ergometry, strength tests, and 6-min walk test [6MWT]).…”

mentioning

confidence: 99%

Exercise Capacity and Functional Performance in Heart Failure Patients Supported by a Left Ventricular Assist Device at Discharge From Inpatient Rehabilitation

et al. 2017

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Adequate physical and functional performance is an important prerequisite for renewed participation and integration in self-determined private and (where appropriate) professional lives following left ventricular assist device (LVAD) implantation. During cardiac rehabilitation (CR), individually adapted exercise programs aim to increase exercise capacity and functional performance. A retrospective analysis of cardiopulmonary exercise capacity and functional performance in LVAD patients at discharge from a cardiac rehabilitation program was conducted. The results from 68 LVAD patients (59 males, 9 females; 55.9 6 11.7 years; 47 HVAD, 2 MVAD, 15 HeartMate II, 4 HeartMate 3, and 4 different implanting centers) were included in the analysis. Exercise capacity was assessed using a cardiopulmonary exercise test on a bicycle ergometer (ramp protocol; 10 W/min). The 6-min walk test was used to determine functional performance. At discharge from CR (53 6 17 days after implantation), the mean peak work load achieved was 62.2 6 19.3 W (38% of predicted values) or 0.79 6 0.25 W/kg body weight. The mean cardiopulmonary exercise capacity (relative peak oxygen uptake) was 10.6 6 5.3 mL/kg/min (37% of predicted values). The 6-min walk distance improved significantly during CR (325 6 106 to 405 6 77 m; P < 0.01). No adverse events were documented during CR. The results show that, even following LVAD implantation, cardiopulmonary exercise capacity remains considerably restricted. In contrast, functional performance, measured by the 6-min walk distance, reaches an acceptable level. Light everyday tasks seem to be realistically surmountable for patients, making discharge from inpatient rehabilitation possible. Long-term monitoring is required in order to evaluate the situation and how it develops further. Key Words: Heart failure-Left ventricular assist deviceCardiac rehabilitation-Exercise capacity-Functional performance.In the last few years, left ventricular assist devices (LVADs) have been increasingly implanted as treatment for terminal heart failure (HF). Whereas initially these systems were only used as a bridge to transplantation (BTT), today approximately half of all recipients have them implanted as the ultimate destination therapy (DT) (1).The overriding therapeutic goal of LVAD implantation is to ensure patient survival and guarantee preservation of organ function (2). However, when patients become permanently dependent on the system, a return to everyday life and restoration of an acceptable quality of life acquire crucial significance. An optimum build-up of exercise capacity and adequate functional performance is therefore very significant. Cardiac rehabilitation (CR) can and should make an important contribution in this context (3,4). After being discharged from a CR center the patients should once more become able to autonomously manage the necessary tasks in their everyday lives back home.Over the last few years, several studies have emerged, most of them small, which report results following rehabilitat...

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“…There are very few exercise training studies in patients with LVAD (5,6,8), and in most of those training studies, exercise intensity was measured through perceived exertion scales and not HR (5,8). Recently, we demonstrated in a randomized controlled trial that patients with continuousflow LVAD exercising at an average of 60% of HRR showed gains in V O 2peak and patient-reported health status (6). This previous finding along with our current data demonstrating good concordance between %HRR and %V O 2 R supports the use of HR as a measure of exercise intensity.…”

Section: Discussionmentioning

confidence: 99%

“…Eligible and consented patients (n = 24) who underwent an LVAD implantation at Henry Ford Hospital (mean duration from implant, 78 T 34 d) and performed a symptom-limited cardiopulmonary exercise test (CPX) as part of cardiac rehabilitation in patients with LVAD (Rehab-VAD) trial (NCT01584895). The complete methods and design for the Rehab-VAD trial have been described previously (6). Eligibility criteria included the following: an implanted continuous-flow LVAD within the previous 6 months, free of orthopedic limitations to exercise, not currently participating in a regular exercise program, and free of any contraindications to exercise.…”

Section: Methodsmentioning

confidence: 99%

Heart Rate and V˙O2 Concordance in Continuous-Flow Left Ventricular Assist Devices

Kerrigan

Williams

Brawner

et al. 2016

Medicine &Amp; Science in Sports &Amp; Exercise

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Cardiac Rehabilitation Improves Functional Capacity and Patient-Reported Health Status in Patients With Continuous-Flow Left Ventricular Assist Devices

Cited by 129 publications

References 22 publications

Efficacy of Inpatient Rehabilitation After Left Ventricular Assist Device Implantation

Efficacy of Inpatient Rehabilitation After Left Ventricular Assist Device Implantation

Exercise Capacity and Functional Performance in Heart Failure Patients Supported by a Left Ventricular Assist Device at Discharge From Inpatient Rehabilitation

Heart Rate and V˙O2 Concordance in Continuous-Flow Left Ventricular Assist Devices

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