Randomised controlled trial of cardiac rehabilitation in elderly patients with heart failure

Abstract

Background: Heart failure, a condition predominantly affecting the elderly, represents an ever-increasing clinical and financial burden for the NHS. Cardiac rehabilitation, a service that incorporates patient education, exercise training and lifestyle modification, requires further evaluation in heart failure management. Aim: The aim of this study was to determine whether a cardiac rehabilitation programme improved on the outcomes of an outpatient heart failure clinic (standard care) for patients, over 60 years of age, with chronic heart failure. Methods: Two hundred patients (60-89 years, 66% male) with New York Heart Association (NYHA) II or III heart failure confirmed by echocardiography were randomised. Both standard care and experimental groups attended clinic with a cardiologist and specialist nurse every 8 weeks. Interventions included exercise prescription, education, dietetics, occupational therapy and psychosocial counselling. The main outcome measures were functional status (NYHA, 6-min walk), health-related quality of life (MLHF and EuroQol) and hospital admissions. Results: There were significant improvements in MLHF and EuroQol scores, NYHA classification and 6-min walking distance (meters) at 24 weeks between the groups ( pb0.001). The experimental group had fewer admissions (11 vs. 33, pb0.01) and spent fewer days in hospital (41 vs. 187, pb0.001). Conclusions: Cardiac rehabilitation, already widely established in the UK, offers an effective model of care for older patients with heart failure.

Geographic issues in cardiac rehabilitation utilization: A narrative review

“…Indeed, for rural patients, factors other than proximity to a program may influence attendance, such as the quality of roads and harsh weather in particular for northern-residing outpatients (Curnier, Savage & Ades 2005, Pell, Morrison 1998). Finally, heart failure patients reported that one of the reasons for nonattendance was anxiety over travel (Austin et al 2005).…”

Feasibility of a group-based self-management program among congestive heart failure patients

“…[15][16][17] Many intervention programs have been developed and evaluated to improve self-management behavior in CHF patients. Some of these-such as telephone-or home-based interventions, [18][19][20] programs in clinical (outpatient) settings, [21][22][23] and groupbased programs [24][25][26] -have demonstrated positive outcomes on health-related quality of life. However, most intervention programs solely emphasize the medical aspects of CHF self-management (eg, symptom recognition), whereas patients face equal difficulties in dealing with the social and emotional consequences of CHF.…”

Quality of Life after Cardiac Rehabilitation for Patients with Heart Failure: 18 months follow-up

“…In general, supervised CR programs are successful in increasing physical fitness, cardiovascular performance, quality of life and reducing mortality [5][6][7][8][9][10][11][12][13][19][20][21][22][23][24].However, there are indicat ions that only 11% to 30% of those who need CR have access to specialized centers [6,22,23,25].Taking these facts into consideration, there has been an increase in the number of programs, whether supervised or not. The effectiveness of these programs has been well documented, revealing broad benefits [19,23,[26][27][28],although other studies have failed to observe positive effects, especially those regarding quality of life [29].In the present study, patients with HF in both groups demonstrated improvement in cardio respiratory fitness and in functional capacity during the 60 intervention days, as verified by other authors [19][20][21]23,[26][27][28].Nevertheless, only the supervised CR group showed quality of life imp rovement along the 60 CR days.…”

“…Several studies have already demonstrated the efficacy o f exercise -based CR programs [7][8][9][10][11], but a meta -analysis of randomized controlled trials [12] has concluded that quality of life improves to similar levels in patients receiving CR and standard care.The aim of the present study was to evaluate the effectiveness of asupervised CR program in the quality of life of HF subjects, as compared to standard care. Success indicators were based on cardiorespiratory capacity analysis, functional capacity, quality of life, survival and/or mortality.…”

“…Card iac rehabilitation (CR) has become mandatory in HF patients. Objectives of CR include mortality and morb idityreduction, quality of life imp rovement and cos reduction [5][6][7][8][9][10][11][12][13].…”