226Effect of the home cardiac rehabilitation program for adult with complex congenital heart disease: The EMPOWER trial

Abstract

Background: Although cardiac rehabilitation has shown benefit in adults with congenital heart disease (ACHD), many patients in developing countries cannot attend the full program due to a logistic problem. We aimed to study the efficiency of once-a-week OPD rehabilitation followed by home program with telemonitoring in this group of patients. Method: Patients who had diagnosed either Eisenmenger's syndrome or complex cyanotic heart disease were included. Training with treadmill and bicycle under supervised at cardiac rehabilitation unit once a week in the first 6 weeks followed by home-program exercise (bicycle and running) with a target at 40-70% of maximum HR at pre-training peak exercise for another 6 weeks was performed. Video and telephone calls were scheduled for evaluation of compliance and complication. Data from cardiopulmonary exercise test (CPET) including peak oxygen uptake (peakVO2), O2 pulse, ventilatory equivalent for CO2 (VE/CO) slope, constant work rate endurance time (CWRET) at 75% peakVO2 and 6-minute walk distance (6MWD) at baseline and after training were compared. Result: From 400 patients in our ACHD clinic, 60 patients were included. Eleven patients who could follow program regularly were assigned home program. There was a statistically significant improvement of CWRET, O2 pulse, and 6MWD after finishing program (p=0.03, 0.039 and 0.01 respectively). The mean difference of 6MWD change in home program group was significantly higher than in control group (69.3±47.9 vs. 4.1±43.4) meters, p=0.001). No serious adverse outcomes were reported. Conclusion: Once-a-week OPD rehabilitation followed by supervised home exercise program showed significant benefit in improvement of exercise capacity in adults with complex congenital heart disease without adverse outcomes (Figure Presented) .