Feasibility of Cardiac Rehabilitation Models in Kenya

Abstract

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.

Role of wearable devices in cardiac telerehabilitation: A scoping review

“…Table 1 summarizes the study and participant characteristics of each study. The most studies were conducted in the United States at 8 studies [ 12 – 19 ], followed by 6 studies in Belgium [ 20 – 25 ]; 4 in Canada [ 17 , 26 – 28 ], the Czech Republic [ 29 – 32 ], Japan [ 33 – 36 ], the Netherlands [ 37 – 40 ], and Poland [ 41 – 44 ]; 3 in China [ 45 – 47 ], and Spain [ 48 – 50 ]; 2 in Australia [ 51 , 52 ], France [ 17 , 53 ], Germany [ 49 , 50 ], Iran [ 54 , 55 ], Italy [ 56 , 57 ], and New Zealand [ 58 , 59 ]; and 1 in Denmark [ 60 ], Finland [ 61 ], Israel [ 62 ], Kenya [ 63 ], Korea [ 64 ], and Portugal [ 65 ]. Three studies were conducted across 3 different countries [ 17 , 49 , 50 ].…”

“…Seventeen studies used heart rate monitors [ 15 , 17 , 20 , 25 , 26 , 29 – 31 , 37 – 40 , 46 , 47 , 52 , 56 ]. 10 used ECG monitors [ 12 , 28 , 34 , 41 – 44 , 48 , 57 , 64 ], 10 used pedometers [ 13 , 18 , 19 , 33 , 36 , 51 , 54 , 55 , 63 , 67 ], 9 used accelerometers [ 21 – 24 , 37 , 53 , 65 , 66 , 68 ], 7 used health watches [ 14 , 16 , 18 , 35 , 60 – 62 ], and 6 used other wearable sensors [ 27 , 45 , 49 , 50 , 58 , 59 ].…”

“…Nine studies were conducted in patients with HF of any left ventricular ejection fraction (LVEF) [ 19 , 21 – 23 , 34 , 35 , 46 , 63 , 66 ], while six studies included patients with heart failure with reduced ejection fraction (LVEF ≤40%) only [ 17 , 28 , 41 – 44 ]. Nine studies had New York Heart Association (NYHA) classification criteria [ 17 , 28 , 35 , 41 – 44 , 46 , 63 ], while 6 studies did not [ 19 , 21 – 23 , 34 , 66 ].…”

Interest of Cardiac Rehabilitation in Patients with Heart Disease in a Cardiology Department in Senegal

“…Heart failure (HF) is a common terminal complication of these CVD. In SSA, heart failure mainly affects young economically active adults, resulting in impaired quality of life and loss of productivity for patients, their families and society in general [3] [4]. In Senegal, the prevalence of heart failure was estimated at 14.28% in 2019 [5].…”

“…Apart from urban areas, there has been little development of CR in sub-Saharan Africa [12]. For instance, in regions such as western Kenya, where the burden of HF is high, CR programs are nonexistent [3]. The same is true in Senegal, where there is only one public cardiac rehabilitation center located in the capital and established in 2015.…”