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A Novel Digital Platform for a Monitored Home-based Cardiac Rehabilitation Program
Published on: April 19, 2019
Multidisciplinary Cardiac Rehabilitation and Long-Term Prognosis in Patients With Heart Failure
Kentaro Kamiya1, Yukihito Sato2, Tetsuya Takahashi3
1Department of Rehabilitation, School of Allied Health Sciences (K.K.), Kitasato University, Kanagawa, Japan.
Insights
Outpatient cardiac rehabilitation (CR) significantly improves survival and reduces rehospitalization for heart failure (HF) patients. These benefits were observed across diverse patient groups, including the elderly and frail.
Area of Science:
- Cardiology
- Rehabilitation Medicine
- Public Health
Background:
- Exercise-based cardiac rehabilitation (CR) is known to improve quality of life and exercise capacity in heart failure (HF) patients.
- The efficacy of CR in specific HF populations, including the elderly, frail, and those with HF with preserved ejection fraction (HFpEF), requires further investigation.
Purpose of the Study:
- To investigate the association between multidisciplinary outpatient CR participation and long-term survival and rehospitalization rates in a large cohort of HF patients.
- To conduct subgroup analyses based on age, sex, comorbidities, frailty, and HFpEF to determine if CR benefits vary across these groups.
Main Methods:
- A multicenter retrospective cohort study involving patients hospitalized for acute HF between 2007 and 2016 across 15 hospitals in Japan.
- Propensity score matching was used to compare outcomes (composite of all-cause mortality and HF rehospitalization, all-cause mortality, HF rehospitalization) between CR participants and non-participants.
Main Results:
- Out of 3277 patients, 862 (26%) participated in outpatient CR. After matching, 1592 patients (796 pairs) were analyzed.
- CR participation was associated with a 23% reduced risk of the composite outcome (HR, 0.77; 95% CI, 0.65-0.92), a 33% reduction in all-cause mortality (HR, 0.67; 95% CI, 0.51-0.87), and a 18% reduction in HF rehospitalization (HR, 0.82; 95% CI, 0.67-0.99).
- Numerically lower composite outcome rates were observed in patients with HFpEF and frail patients participating in CR.
Conclusions:
- Outpatient CR participation demonstrates significant prognostic benefits for a broad spectrum of heart failure patients.
- These benefits appear consistent across various patient demographics and clinical characteristics, including age, sex, comorbidities, frailty, and HFpEF.
Background:
Exercise-based cardiac rehabilitation (CR) improves health-related quality of life and exercise capacity in patients with heart failure (HF). However, CR efficacy in patients with HF who are elderly, frail, or have HF with preserved ejection fraction remains unclear. We examined whether participation in multidisciplinary outpatient CR is associated with long-term survival and rehospitalization in patients with HF, with subgroup analysis by age, sex, comorbidities, frailty, and HF with preserved ejection fraction.
Methods:
This multicenter retrospective cohort study was performed in patients hospitalized for acute HF at 15 hospitals in Japan, 2007 to 2016. The primary outcome (composite of all-cause mortality and HF rehospitalization after discharge) and secondary outcomes (all-cause mortality and HF rehospitalization) were analyzed in outpatient CR program participants versus nonparticipants.
Results:
Of the 3277 patients, 26% (862) participated in outpatient CR. After propensity matching for potential confounders, 1592 patients were included (n=796 pairs), of which 511 had composite outcomes (223 [14%] all-cause deaths and 392 [25%] HF rehospitalizations, median 2.4-year follow-up). Hazard ratios associated with CR participation were 0.77 (95% CI, 0.65-0.92) for composite outcome, 0.67 (95% CI, 0.51-0.87) for all-cause mortality, and 0.82 (95% CI, 0.67-0.99) for HF-related rehospitalization. CR participation was also associated with numerically lower rates of composite outcome in patients with HF with preserved ejection fraction or frail patients.
Conclusions:
Outpatient CR participation was associated with substantial prognostic benefit in a large HF cohort regardless of age, sex, comorbidities, frailty, and HF with preserved ejection fraction.
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