A multidisciplinary cardiac rehabilitation improved aspects of functional performance and health-related quality of life and reduced hospital admissions and length of stay in older people with systolic heart failure

jackie autin, Robert Williams, Linda Ross, Laurie Moseley, Stephen Hutchison

Allbwn ymchwil: Cyfraniad at gyfnodolynErthygladolygiad gan gymheiriaid

Crynodeb

Research objective: To evaluate whether a cardiac rehabilitation program improved on the outcomes of an outpatient heart failure clinic for older adults with chronic heart failure.

Setting: Participations were recruited from the acute medical unit, medical and cardiology outpatient clinics of a hospital in Wales, as well as from general practices in the hospital's catchment area.

Design: Randomised controlled trial with concealed allocation to groups and blinding of assessors for one major outcome. Analysis was by intention to treat. PEDro score: 6 out of 8 for internal validity; 2 out of 2 for statistical reporting (8out of 10 total).

Participants: Two hundred participants (n = 100 intervention; n = 100 control; sample size determined by power calculation). Participants had to be aged 60 years or older, with heart failure (New York Heart Association (NYHA) class II or III), and left ventricular systolic dysfunction (ejection fraction ≤ 40%).

Intervention: Patients in the control group received standard care which consisted of weekly monitoring (for 8 weeks) of clinical status; education about heart failure, treatment, self-monitoring, and diet; and maintenance of their patient health record. In addition to standard care, participants in the intervention group received an 8-week cardiac rehabilitation program (twice a week) and additional group education input (that covered medication, diet, and exercise) from a multidisciplinary team. Individual counselling sessions with the dietician, psychotherapist, or occupational therapist were also available if needed. After this 8-week period, participants then participated in a 16-week community-based exercise program (weekly for 1 h).

Outcome measures: The primary outcome measures were: functional status (NYHA class), functional performance (6-min walk test (6 MWT)), perceived exertion (Borg rating of perceived exertion (Borg RPE); measured prior to and upon completion of the 6 MWT), health-related quality of life (Minnesota Living with Heart Failure questionnaire (MLHF)), and cost-utility (EuroQol). Outcomes were measured at baseline and 24 weeks. The NYHA class and MLHF questionnaire were also administered at 8 weeks. The secondary outcome measures were number and length of stay of hospital admissions arising from heart disease, and prescribed heart failure medication.

Main findings: Participants were comparable at baseline on demographic and clinical variables and on baseline functional performance and quality of life scores. The follow-up rate was 85% in the intervention group and 94% in the control group at 24 weeks. At 24 weeks, there were significant between-group improvements for the NYHA class (improvement in 45% of intervention group participants vs improvement in 11% of control group participants), 6 MWT, MLHF questionnaire, and EuroQol. The intervention group had significantly fewer admissions (11 vs 33) and spent fewer days in hospital (41 vs 187) than the control group.

Authors’ conclusion: Cardiac rehabilitation offers an effective model of care for older patients with heart failure.
Iaith wreiddiolSaesneg
Tudalennau (o-i)316-317
Nifer y tudalennau2
CyfnodolynAustralian Journal of Occupational Therapy
Cyfrol54
Rhif cyhoeddi4
Dynodwyr Gwrthrych Digidol (DOIs)
StatwsCyhoeddwyd - 2007

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