Early rehabilitation in cardiology – heart failure: The ERIC-HF protocol, a novel intervention to decompensated heart failure patients rehabilitation

Abstract

Background: Decompensated heart failure patients are characterised by functional dependence and low exercise tolerance. Aerobic exercise can improve symptoms, functional capacity and an increase in exercise tolerance. However, the benefits of early rehabilitation have not yet been validated. Objective: To evaluate the safety and feasibility of an aerobic exercise training programme in functional capacity of decompensated heart failure patients. Methodology: A single centre, parallel, randomised controlled, open label trial, with 100 patients. The training group (TG, n=50) performed the training protocol and the control group (CG, n=50) performed the usual rehabilitation procedures. The London chest activity of daily living (LCADL) scale, the Barthel index (BI) and the 6 minute walking test (6MWT) at discharge were used to evaluate the efficacy of the protocol. Safety was measured by the existence of adverse events. Results: The mean age of the patients was 70 years, 20% were New York Heart Association (NYHA) class IV and 80% NYHA class III at admission. The major heart failure aetiology was ischaemic (35 patients) and valvular disease (25 patients). There were no significant differences between groups at baseline in terms of sociodemographic or pathophysiological characteristics. There was a statistically significant difference of 54.2 meters for the training group ( P=0.026) in the 6MWT and at LCADL 12 versus 16 ( P=0.003), but the BI did not: 96 versus 92 ( P=0.072). No major adverse events occurred. Conclusions: The training protocol demonstrated safety and efficacy, promoting functional capacity. This study elucidated about the benefits of a systematised implementation of physical exercise during the patient’s clinical stabilisation phase, which had not yet been demonstrated. Trial registration: Clinicaltrials.gov NCT03838003, URL: https://clinicaltrials.gov/ct2/show/NCT03838003 .

The effects of early rehabilitation on functional exercise tolerance in decompensated heart failure patients: Results of a multicenter randomized controlled trial (ERIC-HF study)

“…The trial protocol has been published in a previous report. 13 Patients were recruited from eight cardiology wards (two university hospitals and six regional hospitals). The enrollment started at September 2017 and ended March 2019.…”

“…The Statulator 23 sample size calculator was used for sample size calculation. An effect size was set of 40 meters standard deviation of 110.4 meters (derived from a pilot study, 13 ) the statistical power was set as 0.8 and the alpha as 0.05, yielded a sample size of 120 for each group to achieves. Assuming a 15% drop-out rate, 276 patients in total were needed.…”

“… 10 Early rehabilitation in patients with DHF was associated with a higher rates of recovery in ADL 11 and improved sleep quality. 12 A pilot study 13 showed that aerobic training in patients with DHF was safe and feasible. Therefore, the aim of this trial is to test the effects of aerobic training on functional exercise tolerance of patients with DHF, on functional independence and dyspnea during ADL.…”

Ganhos com o programa de reabilitação e ensino à pessoa com insuficiência cardíaca (Programa REPIC)

“…Para além disso, o estudo ERIC-HF revela um incremento da capacidade funcional (avaliada pelo teste de marcha de 6 minutos e na realização das atividades de vida diárias). As conclusões deste estudo revelaram diferenças estatisticamente significativas de 54,2 metros para o grupo de treino (p=0,026) no teste de marcha de 6 minutos e na realização das atividades de vida diárias (p=0,003), mas não no nível de dependência, avaliado pelo índice de Barthel (p=0,072) (25) .…”

Reabilitação respiratória domiciliária na doença pulmonar obstrutiva crónica: estudo de caso

“…A pontuação mínima de 0 corresponde à dependência máxima para todas as AVD avaliadas e a pontuação máxima de 100 é igual à independência total da mesma AVD (8) . Fácil aplicação e interpretação, preenchimento rápido, baixo custo de aplicação, possibilidade de repetição periódica (o que permite monitoração longitudinal) são algumas características que tornam este instrumento um das mais utilizadas em ensaios clínicos para avaliar o grau de dependência na realização de dez exercícios básicos (9) . O PRR teve a duração de 8 semanas, com sessões bissemanais e acompanhamento telefónico sempre que necessário para apoio ao utente e à família (2) .…”