Economic Evaluation of Exercise Training in Patients with Pulmonary Hypertension

Ehlken, Nicola; Verduyn, Cora; Tiede, Henning; Staehler, G.; Karger, Gabriele; Nechwatal, Robert; Opitz, Christian; Klose, Hans; Wilkens, Heinrike; Rosenkranz, Stephan; Halank, Michael; Grünig, Ekkehard

doi:10.1007/s00408-014-9558-9

Cited by 40 publications

(32 citation statements)

References 21 publications

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“…A recent report also demonstrated that exercise training may lead to reduced health care costs (reduction in costs of EUR 657/patient within a period of 2 years) [33]. The main cost reduction was caused by less initiation of PH-targeted treatment.…”

Section: Clinical Effects Of Exercise Training On Phmentioning

confidence: 99%

“…However, even though some studies reported excellent survival rates over a follow-up period of up to 3 years (97-100% at 1 year, 94-100% at 2 years and 80-86% at 3 years) [10,11,33,34], to date no study was designed to assess whether exercise training provided patients with a measurable survival advantage. An RCT with survival or at least time to clinical worsening as primary endpoint would be necessary and useful.…”

Section: Clinical Effects Of Exercise Training On Phmentioning

confidence: 99%

“…Indeed, in most cases, exercise training is hampered by the limited availability and high costs of inpatient rehabilitation. In most studies [7,8,10,11,12,32,33,34], the training program consisted of a first part of a 3-week inpatient rehabilitation program and a second part of a 12-week home-based individualized training program. After the first part had been performed in a specialized rehabilitation clinic, all patients received a bicycle ergometer for use at home and were asked to continue the bicycle exercise training close to their target HR once daily for a total of 15-30 min for 5 days a week.…”

Section: Self-management (Continuation Of Training)mentioning

confidence: 99%

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Principles of Rehabilitation and Reactivation: Pulmonary Hypertension

et al. 2015

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Most recently, a specialized and carefully monitored exercise training and rehabilitation program has been recommended as add-on to medical treatment in patients with pulmonary arterial hypertension (class I, level of evidence A). Three prospective randomized, controlled trials, 10 prospective uncontrolled trials, 2 retrospective studies and 2 case series in more than 470 patients with severe pulmonary hypertension (PH) and right heart failure reported beneficial effects of a specialized exercise training and rehabilitation program, i.e. significant improvement in symptoms, exercise capacity, cardiorespiratory function and quality of life, compared with untrained controls. All training studies reported an acceptable safety profile, and some uncontrolled studies showed excellent 1- and 2-year survival rates. However, most studies had a quite small sample size (ranging from 2 to 183 patients) and an uncontrolled design, and they were not designed to assess hemodynamic changes, time to clinical worsening and survival. Nevertheless, there is large evidence that exercise training programs should be performed by centers experienced in both PH patient care and rehabilitation. The best method and duration of the training, characteristics of supervision, and the mechanisms resulting in symptom improvement and increased functional capacity are unclear. In this review, we summarize data of molecular and clinical effects of exercise training in PH patients. Furthermore, we discuss safety data and the role of a self-care management of exercise training in these patients.

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Section: Clinical Effects Of Exercise Training On Phmentioning

confidence: 99%

Section: Clinical Effects Of Exercise Training On Phmentioning

confidence: 99%

Section: Self-management (Continuation Of Training)mentioning

confidence: 99%

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Principles of Rehabilitation and Reactivation: Pulmonary Hypertension

et al. 2015

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“…After 3 and 15 weeks, patients significantly improved the 6MWD compared to baseline, scores of quality of life, WHO functional class, peak oxygen consumption, oxygen pulse, HR and systolic pulmonary artery pressure at rest and maximal workload (71). Due to less worsening events within 2 years, average healthcare costs lower of €675,00 in the group of patients who performed a specialized rehabilitation program (72). Obviously, non-RCT design presented several potential bias, but no published study contrasted the safety and potential benefits of ET for PAH patients anyway.…”

Section: Other Non-rcts Studies In Humansmentioning

confidence: 95%

Exercise training for patients with pulmonary arterial hypertension

Confalonieri¹

2014

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ly activity, reducing dyspnoea and fatigue, and enhancing the quality of life and muscle strength. So, the final message from the available literature reports is a strong recommendation to adopt exercise training and cardiopulmonary rehabilitation programs for any patient suffering from exertional dyspnoea and fatigue. Many questions remain unanswered regarding the optimization of the exercise training and rehabilitation programs. Ongoing rehabilitative trials in patients with PAH will help answer some of the remaining questions.KEY WORDS: pulmonary arterial hypertension; dyspnoea; exercise limitation; exercise training; pulmonary rehabilitation. IntroductionPulmonary arterial hypertension (PAH) is a hemodynamic condition defined by a pre-capillary resting pulmonary artery pressure at or above 25 mm Hg mean value that can be the result of a variety of diseases of different causes, but similar clinical picture and virtually identical pathological changes of the distal pulmonary arteries (1, 2). During the Fifth World Symposium on pulmonary hypertension (PH) held in 2013 in Nice, the clinical classification of pulmonary hypertension (2) identified five groups of disorders according to pathological, pathophysiological and therapeutic characteristics, but the term PAH may only be applied to a subgroup of the group 1 including eight rare clinical conditions characterized by pre-capillary PH in absence of other causes of pre-capillary PH such as lung diseases, chronic pulmonary thromboembolism (CTEPH), or rare diseases related-PH with unclear multi-factorial mechanisms. Despite a number of specific drugs are available by now for PAH treatment, exertional dyspnoea is a common progressively disabling symptom, shared either by idiopathic and secondary PAH, still affecting well treated patients. Exercise training (ET), a major component of pulmonary rehabilitation programs, is an established treatment to enhance exercise limitation for patients with chronic obstructive pulmonary disease (COPD), systolic left heart failure, and a variety of chronic respiratory diseases (3 SummaryIn spite of evidence-based consensus recommendations on exercise training for patients with pulmonary arterial hypertension (PAH) its use outside specialized rehabilitation Centers has been accounted a handful of reports. Dyspnoea and fatigue are common symptoms reducing the exercise tolerance of subjects with PAH even when specific drug are correctly administered. Moreover, the mechanisms of exercise limitation in subjects with PAH are known and thandful of reports. There is evidence of impaired signaling between the periphery and central hemodynamic performance. Exercise training has recently been proven to be effective and safe to enhance physical performance in patients with PAH already treated with specific drug therapy. The rationale of training in PAH has been specifically proven also in experimental animal models of PAH. Moreover, repeated positive results in randomized controlled trials and observational studies in humans gave convincing ...

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“…4 Notwithstanding these pitfalls, the role of exercise training does appear to have significant benefits as an adjunct to pharmacotherapy and has been shown to be cost-effective in a European setting. 5 However, the expansion of these findings to a global context is crucial for the inclusion of exercise training in the PH treatment and rehabilitation guidelines. There is therefore a great need for more robust clinical trials in this area of exercise training for patients with PH.…”

mentioning

confidence: 99%