Outcomes With Multidisciplinary Cardiac Rehabilitation in Post-acute Systolic Heart Failure Patients—A Retrospective Propensity Score-Matched Study

Abstract

BackgroundCardiac rehabilitation (CR) is recommended for patients with acute heart failure (HF). However, the results of outcome studies and meta-analyses on CR in post-acute care are varied. We aimed to assess the medium- to long-term impact of CR and ascertain the predictors of successful CR.MethodsIn this propensity score-matched retrospective cohort study, records of consecutive patients who survived acute HF (left ventricular ejection fraction <40) and participated in a multidisciplinary HF rehabilitation program post-discharge between May 2014 and July 2019 were reviewed. Patients in the CR group had at least one exercise session within 3 months of discharge; the others were in the non-CR group. After propensity score matching, the primary (all-cause mortality) and secondary (HF readmission and life quality assessment) outcomes were analyzed.ResultsAmong 792 patients, 142 attended at least one session of phase II CR. After propensity score matching for covariates related to HF prognosis, 518 patients were included in the study (CR group, 137 patients). The all-cause mortality rate was 24.9% and the HF rehospitalization rate was 34.6% in the median 3.04-year follow-up. Cox proportional hazard analysis revealed that the CR group had a significant reduction in all-cause mortality compared to the non-CR group (hazard ratio [HR]: 0.490, 95% confidence interval [CI]: 0.308–0.778). A lower risk of the primary outcome with CR was observed in patients on renin-angiotensin-aldosterone system (RAAS) inhibitors, but was not seen in patients who were not prescribed this class of medications (interaction p = 0.014).ConclusionsCardiac rehabilitation participation was associated with reduced all-cause mortality after acute systolic heart failure hospital discharge. Our finding that the benefit of CR was decreased in patients not prescribed RAAS inhibitors warrants further evaluation.

Global research publications on cardiovascular and pulmonary rehabilitation and their alignment with population rehabilitation needs: An ecological study

“…Additionally, we focused on YLD Rates for CVD (except stroke) as the only contributor to CR needs. However, CR and broader exercise‐based interventions have been recently emerging as effective also for other conditions, such as example heart failure 26–28 . Yet, that evidence is still emerging (i.e., with some methodological gaps yet) 29 .…”

“…However, CR and broader exercise-based interventions have been recently emerging as effective also for other conditions, such as example heart failure. [26][27][28] Yet, that evidence is still emerging (i.e., with some methodological gaps yet). 29 Within a conservative approach, here we included only YLDs from an underlying CVD cause.…”

Benefit of cardiac rehabilitation in acute heart failure patients with cognitive impairment

“…This retrospective study evaluated patients hospitalized for AHF between March 2015 and May 2021 at the Heart Failure Center of Kaohsiung Chang Gung Memorial Hospital. Patients who fulfilled the following inclusion criteria were enrolled in this study [ 1 ]: survived at discharge [ 2 ], underwent cognitive and psychological functional assessments [ 3 ], aged ≥20 years [ 4 ], left ventricular ejection fraction (LVEF) ≤40 % on echocardiography or other methods, and [ 6 ] heart failure disease management coordinated by an HF specialist nurse as described previously [ 7 ]. The exclusion criteria were as follows [ 1 ]: an estimated survival time of <6 months [ 2 ], long-term bedridden (>3 months) [ 3 ], terminal heart status, and [ 4 ] cannot cooperate with all functional studies.…”

“…Patients were advised to undergo phase II CR within 1 month from discharge. Moderate continuous aerobic exercise training was prescribed individually according to the CPET result [ 4 ]. The training intensity was within 10 beats of the anaerobic threshold or 40–60 % of peak VO 2 .…”

“…Multidisciplinary cardiac rehabilitation (CR) can improve the mid-to long-term survival rates of patients with heart failure [ 4 ]. Lifestyle modifications and exercise can also improve cognitive function in patients with HF(5).…”