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A Novel Digital Platform for a Monitored Home-based Cardiac Rehabilitation Program
Published on: April 19, 2019
Autonomic dysfunction predicts poor physical improvement after cardiac rehabilitation in patients with heart failure
Leonida Compostella1, Russo Nicola2, Setzu Tiziana1
1Preventive Cardiology and Rehabilitation, Institute Codivilla-Putti, Cortina d'Ampezzo, Italy.
Insights
Reduced heart rate variability (HRV) in congestive heart failure (CHF) patients predicts poor physical fitness improvement after cardiac rehabilitation. Minimum heart rate also indicates limited exercise capacity in these patients.
Area of Science:
- Cardiology
- Autonomic Nervous System Function
- Exercise Physiology
Background:
- Cardiac autonomic dysfunction, indicated by reduced heart rate variability (HRV), is common in congestive heart failure (CHF) and linked to left ventricular dysfunction.
- While HRV indicates performance improvement in athletes, its predictive value for exercise capacity in CHF patients is not well-established.
- Reduced HRV is a known marker of autonomic dysfunction in heart failure patients.
Purpose of the Study:
- To determine if heart rate variability (HRV) can predict physical fitness improvements in congestive heart failure (CHF) patients undergoing cardiac rehabilitation (CR).
- To assess the relationship between HRV parameters and exercise capacity changes following a short-term, exercise-based CR program.
Main Methods:
- An observational study of 57 advanced CHF patients (ejection fraction ≤ 35%) in stable condition.
- 24-hour Holter monitoring assessed HRV and heart rate (HR) at admission.
- Physical fitness evaluated by 6-minute walking test (6MWT) and cardiopulmonary exercise test (CPET) before and after two weeks of CR.
Main Results:
- Patients with very low HRV (SDNN 55.8 ± 10.0 ms) showed no improvement in walking capacity post-CR.
- These patients achieved shorter final 6MWT distances (348 ± 118 m) and had significantly lower peak oxygen consumption (VO2) on CPET compared to those with higher HRV.
- Minimum HR, not mean HR, negatively correlated with exercise capacity (CPET performance).
Conclusions:
- Depressed HRV and elevated minimum HR predict poor exercise capacity in advanced CHF patients after short-term CR.
- These findings suggest that individualized and intensive rehabilitation strategies are crucial for CHF patients with autonomic dysfunction.
- HRV assessment may aid in tailoring cardiac rehabilitation programs for CHF patients.
Background:
Cardiac autonomic dysfunction, clinically expressed by reduced heart rate variability (HRV), is present in patients with congestive heart failure (CHF) and is related to the degree of left ventricular dysfunction. In athletes, HRV is an indicator of ability to improve performance. No similar data are available for CHF.
Objectives:
The aim of this study was to assess whether HRV could predict the capability of CHF patients to improve physical fitness after a short period of exercise-based cardiac rehabilitation (CR).
Patients And Methods:
This was an observational, non-randomized study, conducted on 57 patients with advanced CHF, admitted to a residential cardiac rehabilitation unit 32 ± 22 days after an episode of acute heart failure. Inclusion criteria were sinus rhythm, stable clinical conditions, no diabetes and ejection fraction ≤ 35%. HRV (time-domain) and mean and minimum heart rate (HR) were evaluated using 24-h Holter at admission. Patients' physical fitness was evaluated at admission by 6-minute walking test (6MWT) and reassessed after two weeks of intensive exercise-based CR. Exercise capacity was evaluated by a symptom-limited cardiopulmonary exercise test (CPET).
Results:
Patients with very depressed HRV (SDNN 55.8 ± 10.0 ms) had no improvement in their walking capacity after short CR, walked shorter absolute distances at final 6MWT (348 ± 118 vs. 470 ± 109 m; P = 0.027) and developed a peak-VO2 at CPET significantly lower than patients with greater HRV parameters (11.4 ± 3.7 vs. an average > 16 ± 4 mL/kg/min). Minimum HR, but not mean HR, showed a negative correlation (ρ = -0.319) with CPET performance.
Conclusions:
In patients with advanced CHF, depressed HRV and higher minimum HR were predictors of poor working capacity after a short period of exercise-based CR. An individualized and intensive rehabilitative intervention should be considered for these patients.
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