Effects of Combined Early In-Patient Cardiac Rehabilitation and Structured Home-based Program on Function among Patients with Congestive Heart Failure: A Randomized ontrolled Trial

Abstract

Aims:To determine the effects of combined in-patient rehabilitation with a home-based program on function and quality of life.Setting and Design:Tertiary care, university teaching hospital, randomized controlled trial.Patients and Methods:Thirty admitted patients with congestive heart failure with New York Heart Association class II -IV. A five step individualised phase-1 cardiac rehabilitation program followed by a structured home based rehabilitation for eight weeks was given to the experimental group while the control group only received physician directed advice. Six minute walk distance was assessed at discharge and follow-up, while quality of life (SF36) was assessed at admission, discharge, and follow-up.Statistical analysis used:Independent t-test, paired t-test and repeated measures ANOVA with Bonferroni post-hoc analysis.Results:At admission patients in both the groups were comparable. After the phase-1 cardiac rehabilitation, there was a change in the six minute walk distance between control and experimental group (310 m vs. 357 m, respectively; P = 0.001). Following the eight week home-based program, there was a greater increase in six minute walk distance in the experimental group when compared to the control group (514 m vs. 429 m; P < 0.001). Quality of life as measured by the SF-36 at the end of 8-weeks showed a statistically significant difference (P < 0.05) in the experimental group for both the mental and physical components.Conclusion:Early in-patient rehabilitation followed by an eight week home based exercise program improves function and quality of life in patients with congestive heart failure.

Cardiac Rehabilitation in India

“…Studies from various centers have assessed the benefits of early mobilization for patients with STEMI and HF. 40,45 Phase II CR has been implemented among those following interventions for CHD with promising results seen with regard to exercise capacity and QoL. 43 To the best of the authors' knowledge, there is currently no published literature that has assessed the benefits of phase III and IV CR in India.…”

“…To the best of our knowledge only two published studies on ET in HF are available from India (i.e., one case series and one clinical trial). 44,45 The interventional study was a small randomized controlled trial utilizing an eight week home based ET program for patients with HF. The study found statistically significant improvements in QoL and functional capacity.…”

Exercise Training as Therapy for Heart Failure

“…(58) HF-ACTION, the largest study of exercise training in a HF population, specifically excluded patients with any clinical instability, including hospitalization, within 6 weeks of enrollment. (4) The current literature regarding the safety and efficacy of exercise interventions that specifically target patients with AHFS is limited to observational data (59) and a small randomized trial (60), both of which showed benefit. A state-of-the-art review (7) and the recent Center for Medicare and Medicaid Services (CMS) coverage memo for cardiac rehabilitation (CR) in patients with chronic stable HF specifically exclude patients with AHFS or recent (4–6 weeks) hospitalization, and call for a period of stability prior to enrollment in CR.…”

Heart Failure in South Asia

“…Establishing dedicated HF clinics will be one way to tackle this problem. Dedicated HF rehabilitation programmes have been found successful in Indian settings also even though in small number of patients [88]. Imparting training and providing continued medical education to physicians will improve the management of HF patients.…”