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A Novel Digital Platform for a Monitored Home-based Cardiac Rehabilitation Program
Published on: April 19, 2019
Feasibility of Cardiac Rehabilitation Models in Kenya
G Titus K Ngeno1,2, Felix Barasa2, Jemimah Kamano2
1Duke University, Durham, NC, US.
Insights
Cardiac rehabilitation (CR) models, including institution-based and home-based, are feasible for heart failure (HF) patients in Western Kenya. Further research is needed to determine the effectiveness of CR in this population.
Area of Science:
- Cardiology
- Public Health
- Rehabilitation Medicine
Background:
- Heart failure (HF) poses a significant health burden in Sub-Saharan Africa.
- Cardiac rehabilitation (CR) improves outcomes but faces access and adherence challenges globally.
- No CR programs currently exist in regions like Western Kenya.
Purpose of the Study:
- To assess the feasibility of implementing CR for HF patients in Western Kenya.
- To evaluate adherence rates for institution-based CR (IBCR) and home-based CR (HBCR) models.
- To explore preliminary changes in functional capacity and symptoms.
Main Methods:
- 100 participants with NYHA class II-III HF were enrolled in Western Kenya.
- Participants were assigned to IBCR (facility-based sessions) or HBCR (pedometer-guided).
- Feasibility was defined as adherence to at least 25% of exercise sessions; NYHA class and 6-minute walk distance (6MWTD) were secondary outcomes.
Main Results:
- Both IBCR and HBCR models demonstrated adherence above 25% (46% ± 18% and 29% ± 11%, respectively).
- Improvements in NYHA class were observed in 71% (IBCR), 41% (HBCR), and 54% (Observational Arm).
- Significant increases in 6MWTD were noted across all groups, including IBCR, HBCR, and the observational arm.
Conclusions:
- Institution-based and home-based CR models are feasible for HF patients in Western Kenya.
- While functional capacity improved, the overall effectiveness of CR in this setting requires further investigation.
- Randomized trials are recommended to evaluate the efficacy, safety, and effect size of CR in low-resource contexts.
Background:
Heart failure (HF), is a leading cause of cardiovascular morbidity and mortality in Sub-Saharan Africa. Cardiac rehabilitation (CR) is known to improve functional capacity and reduce morbidity associated with HF. Although CR is a low-cost intervention, global access and adherence rates to CR remain poor. In regions such as Western Kenya, CR programs do not exist. We sought to establish the feasibility CR for HF in this region by testing adherence to institution and home-based models of CR.
Methods:
One hundred participants with New York Heart Association (NYHA) class II and III HF symptoms were prospectively enrolled from a tertiary health facility in Western Kenya. Participants were non-randomly assigned to participate in one of two CR models based on their preference. Institution based cardiac rehabilitation (IBCR) comprised 36 facility-based exercise sessions over a period of 12 weeks. Home based cardiac rehabilitation (HBCR) comprised weekly pedometer guided exercise targets over a period of 12 weeks. An observational arm (OA) receiving usual care was also enrolled. The primary endpoint of CR feasibility was assessed based on study participants to adherence to at least 25% of exercise sessions. Secondary outcomes of change in NYHA symptom class, and six-minute walk time distance (6MWTD) were also evaluated. Data were summarized and analyzed as means (SD) and frequencies. Paired t-tests, Chi Square, Fisher's, and ANOVA tests were used for comparisons.
Findings:
Mean protocol adherence was greater than 25% in both CR models; 46% ± 18 and 29% ± 11 (P < 0.05) among IBCR and HBCR participants respectively. Improvements by at least one NYHA class were observed among 71%, 41%, and 54%, of IBCR, HBCR and OA participants respectively. 6MWTD increased significantly by a mean of 31 ± 65 m, 40 ± 55 m and 38 ± 71 m in the IBCR, HBCR and OA respectively (P < 0.05).
Conclusions:
IBCR and HBCR, are feasible rehabilitation models for HF in Western Kenya. Whereas improvement in functional capacity was observed, effectiveness of CR in this population remains unknown. Future randomized studies evaluating effect size, long term efficacy, and safety of cardiac rehabilitation in low resource settings such as Kenya are recommended.
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