AbstractHeart failure, a condition predominantly affecting the elderly, represents an ever increasing clinical and financial burden for the NHS. Patients with symptomatic heart failure have a pooi prognosis and a high degree of morbidity. Current research findings suggest that enhancemeni of self-care through education, optimisation of pharmacological therapy, exercise training, lifestyle modification and counselling improves patient outcomes and reduces hospitalization.
Cardiac rehabilitation, a service that incorporates all the aforementioned components, has yet to be evaluated in heart failure management.
Set in a district general hospital with a primary catchment area of 500,000 inhabitants, this study is among the first of its type in the U.K. The study evaluates the effects of a cardiac rehabilitation programme on a range of outcome measures: mortality, health related quality of life, functional change, health care utilisation and clinical status. The design is a randomised controlled trial, comparing cardiac rehabilitation to standard care.
Two hundred patients (60 - 89 years, 66% male) were recruited from hospital clinics, wards, and general practice. Patients with NYHAII or in heart failure confirmed, by echocardiography, were randomly allocated to control or experimental groups. Both patient groups attended out patient appointments to see the specialist nurse and cardiologist every eight weeks. In addition, patients in the experimental group attended cardiac rehabilitation
classes twice weekly for eight weeks, followed by weekly exercise sessions for 16 weeks. Intervention consisted of exercise prescription, education, dietetics, occupational therapy and psychosocial counselling. A selection of measures were used to collect data over six months: Minnesota Living with Heart Failure (MLHF), New York Heart Association (NYHA) functional classification, EuroQol (EQ-5D), the six-minute walk test, Borg's rating of perceived exertion (RPE), medication compliance monitored by ACE inhibition, routine biochemisty, prescribed medication, coronary risk factor status, medical records and patient diaries.
Results show statistically significant improvements for the experimental group in comparison to control patients. Improvements were identified in health related quality of life, functional status, metrs walked and patient cost utility; a reduction in hospital admissions attributable to heart disease was evident. No statistical difference between patient groups was evident in mortality, contact with primary health care professionals, compliance and clinical status. The
findings are discussed in terms of previous rehabilitation studies.
In conclusion, this study describes the necessary infrastructure and provides an evidence base for implementing a successful multidisciplinary cardiac rehabilitation programme in a district general hospital.
|Date of Award||Jun 2003|
|Supervisor||Linda Ross (Supervisor) & Robert Williams (Supervisor)|