Multidisciplinary Cardiac Rehabilitation and Long-Term Prognosis in Patients With Heart Failure

Abstract

Background: Exercise-based cardiac rehabilitation (CR) improves health-related quality of life and exercise capacity in patients with heart failure (HF). However, CR efficacy in patients with HF who are elderly, frail, or have HF with preserved ejection fraction remains unclear. We examined whether participation in multidisciplinary outpatient CR is associated with long-term survival and rehospitalization in patients with HF, with subgroup analysis by age, sex, comorbidities, frailty, and HF with preserved ejection fraction. Methods: This multicenter retrospective cohort study was performed in patients hospitalized for acute HF at 15 hospitals in Japan, 2007 to 2016. The primary outcome (composite of all-cause mortality and HF rehospitalization after discharge) and secondary outcomes (all-cause mortality and HF rehospitalization) were analyzed in outpatient CR program participants versus nonparticipants. Results: Of the 3277 patients, 26% (862) participated in outpatient CR. After propensity matching for potential confounders, 1592 patients were included (n=796 pairs), of which 511 had composite outcomes (223 [14%] all-cause deaths and 392 [25%] HF rehospitalizations, median 2.4-year follow-up). Hazard ratios associated with CR participation were 0.77 (95% CI, 0.65–0.92) for composite outcome, 0.67 (95% CI, 0.51–0.87) for all-cause mortality, and 0.82 (95% CI, 0.67–0.99) for HF-related rehospitalization. CR participation was also associated with numerically lower rates of composite outcome in patients with HF with preserved ejection fraction or frail patients. Conclusions: Outpatient CR participation was associated with substantial prognostic benefit in a large HF cohort regardless of age, sex, comorbidities, frailty, and HF with preserved ejection fraction.

Current Status and Effect of Outpatient Cardiac Rehabilitation After Percutaneous Coronary Intervention in Japan

“…Kamiya et al reported that the multidisciplinary team approach, including exercise and patient education, is effective in patients with heart failure. 23 The combination of interventions must have resulted in higher motivation and better self-management skills, and consequently a reduction in the risk of all-cause mortality and acute heart failure.…”

Prevalence and prognostic value of the coexistence of anaemia and frailty in older patients with heart failure

“…35 On the other hand, outpatient cardiac rehabilitation participation was associated with reduced risks of all-cause death and HF rehospitalization in frail patients with HF. 36 A new trial, the REHAB-HF study, is currently underway, and this pilot study has shown that rehabilitation therapy beginning in the hospital improved 6MWD and SPPB score, with the strongest trend seen with chair stands, in hospitalized older patients with HF, and the change in SPPB score was strongly related to all-cause rehospitalization. 37 Tissue oxygenation is decreased by anaemia and hypoxia, which may lead to functional impairment of muscle.…”

“…Although the role of intravenous iron therapy in acute HF is not yet clear, a new trial, AFFIRM‐AHF, is currently underway with the composite of recurrent HF hospitalizations and cardiovascular mortality as the primary outcome 35 . On the other hand, outpatient cardiac rehabilitation participation was associated with reduced risks of all‐cause death and HF rehospitalization in frail patients with HF 36 . A new trial, the REHAB‐HF study, is currently underway, and this pilot study has shown that rehabilitation therapy beginning in the hospital improved 6MWD and SPPB score, with the strongest trend seen with chair stands, in hospitalized older patients with HF, and the change in SPPB score was strongly related to all‐cause rehospitalization 37 …”

Characteristics of Elderly Patients with Heart Failure and Impact on Activities of Daily Living: A Registry Report from Super-Aged Society

“…Comprehensive cardiac rehabilitation programs have been shown to improve the prognosis of patients with HF [6][7][8], although their efficacy for "very elderly" individuals and their impact on improving ADL are unknown. Thus, we conducted a registry study to clarify the effect of cardiac REHAbilitation with multidisciplinary intervention for Chronic Heart Failure of ELDerly patients (J-REHACHF-ELD study) in a super-aged society and ascertain the real figure of HF in elderly patients and efficacy of rehabilitation measures.…”