Cardiac rehabilitation improves functional capacity and patient-reported health status in patients with continuous-flow left ventricular assist devices: the Rehab-VAD randomized controlled trial
Dennis J Kerrigan, Celeste T Williams, Jonathan K Ehrman, Matthew A Saval, Kyle Bronsteen, John R Schairer, Meghan Swaffer, Clinton A Brawner, David E Lanfear, Yelena Selektor, Mauricio Velez, Cristina Tita, Steven J Keteyian, Dennis J Kerrigan, Celeste T Williams, Jonathan K Ehrman, Matthew A Saval, Kyle Bronsteen, John R Schairer, Meghan Swaffer, Clinton A Brawner, David E Lanfear, Yelena Selektor, Mauricio Velez, Cristina Tita, Steven J Keteyian
Abstract
Objectives: This study examined the effects of a cardiac rehabilitation (CR) program on functional capacity and health status (HS) in patients with newly implanted left ventricular assist devices (LVADs).
Background: Reduced functional capacity and HS are independent predictors of mortality in patients with heart failure. CR improves both, and is related to improved outcomes in patients with heart failure; however, there is a paucity of data that describe the effects of CR in patients with LVADs.
Methods: Enrolled subjects (n = 26; 7 women; age 55 ± 13 years; ejection fraction 21 ± 8%) completed a symptom-limited cardiopulmonary exercise test, the Kansas City Cardiomyopathy Questionnaire (KCCQ), a 6-min walk test (6MW), and single-leg isokinetic strength test before 2:1 randomization to CR versus usual care. Subjects in the CR group underwent 18 visits of aerobic exercise at 60% to 80% of heart rate reserve. Within-group changes from baseline to follow-up were analyzed with a paired t-test, whereas an independent t-test was used to determine differences in the change between groups.
Results: Within-group improvements were observed in the CR group for peak oxygen uptake (10%), treadmill time (3.1 min), KCCQ score (14.4 points), 6MW distance (52.3 m), and leg strength (17%). Significant differences among groups were observed for KCCQ, leg strength, and total treadmill time.
Conclusions: Indicators of functional capacity and HS are improved in patients with continuous-flow LVADs who attend CR. Future trials should examine the mechanisms responsible for these improvements, and if such improvements translate into improved clinical outcomes. (Cardiac Rehabilitation in Patients With Continuous Flow Left Ventricular Assist Devices:Rehab VAD Trial [RehabVAD]; NCT01584895).
Keywords: Kansas City Cardiomyopathy Questionnaire; cardiac rehabilitation; cardiopulmonary exercise testing; end-stage heart failure; exercise training; left ventricular assist device.
Copyright © 2014 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
Source: PubMed