Referral and results of exercise training after hospitalisation for heart failure: a comparison with patients after acute coronary syndrome or cardiac surgery

Abstract

Purpose: Exercise training has been shown to be beneficial in patients with Heart Failure (HF). We evaluated the participation rate in exercise training after hospitalisation for HF as compared to patients hospitalised for Acute Coronary Syndrome (ACS) or cardiac surgery. Training results were compared between these patient populations and clinical characteristics for non-participation in the HF population were investigated. Methods: Between January 2010 and May 2012 we prospectively evaluated patients who were hospitalised for HF (HF group, n=428), ACS (ACS group, n=467) or cardiac surgery (surgery group, n=358) as well as patients who started a cardiac rehabilitation program (REHAB group, n=371). HF patients who participated in exercise training were compared to HF patients who did not participate. Then, the percentage change in peak V02 and 6-Minutes Walking Distance (6MWD) after exercise training was compared between HF patients and patients after ACS or cardiac surgery in the REHAB group. Results: Of the total HF group, only 37 (9%) participated in an exercise training program in contrast to a participation rate of 29% in the ACS group and 56% in the surgery group. HF patients who didn't participate in exercise training were older (79±10 vs 65±10 years, p<0.001) and more frequently female (48% vs 24%, p=0.005) They had more frequently hypertension (65% vs 49%, p=0.053) and AF on admission (46% vs 19%, p=0.001). Non-participation was also associated with more difficulties with mobility, one out of four was not able to walk independently on discharge (26% vs none p=0.002). In the REHAB group, these 37 HF patients had higher NT-proBNP and lower peakVO2 values at the start of the exercise training as compared to the patients after ACS (n=133) or after cardiac surgery (n=201) (2331 ±3484 pg/ml vs 652±838 pg/ml vs 804±916 pg/ml, p<0.001 for NT-proBNP and 16.2±4.5 vs 21.7±5.8 vs 17.8±5.3 ml/kg/min, p<0.001 for peakVO2). However, they obtained a similar percentage increase in VO2 max and 6 MWD as compared to the patients after ACS or after cardiac surgery (20% vs 18% vs 21% increase in peak VO2 and 30% vs 28% vs 28% increase in 6MWD) Conclusions: Although the benefits of an exercise training program for heart failure patients is comparable to the benefits obtained in patients after ACS or cardiac surgery, only 9% actually participates after an episode of hospitalisation for acute heart failure. Clinical characteristics which may be a barrier for attending rehabilitation should be the focus of further research in order to increase the participation rate of HF patients in exercise training.