A pilot study to explore the effectiveness of “early” rehabilitation after a hospital admission for chronic heart failure

Abstract

People with chronic heart failure (CHF) experience acute exacerbations of their symptoms. These episodes are costly to patients and the health service. The study was a single group, pretest and posttest design. Seventeen patients with left ventricular systolic dysfunction (LVSD) started rehabilitation within 4 weeks of hospital discharge. The 6 week rehabilitation programme included exercise and self-management education. The hospital anxiety and depression scale (HADS), the incremental and endurance shuttle walking tests (ISWT/ESWT) were assessed at baseline and after rehabilitation. The number and duration of any CHF admissions in the year before and the year after rehabilitation were also recorded. Improvements in the ISWT, ESWT, and depression were, mean (95% confidence interval [CI]) 60.6 (36.0–85.2) metres, 356.0 (173.0–539.0) seconds (both p ≤ 0.001) and −1.0 (−1.8–−0.2) points (p < 0.05), respectively. HADS anxiety improvements failed to reach significance. At 1 year, there was a significant decrease in CHF-related hospitalisations, mean change (95% CI) −0.8 (−1.1–−0.4), p ≤ 0.001 and CHF bed days −13.0 (−24.4–−1.6), p < 0.05. Early rehabilitation significantly improved exercise capacity and depression and reduced CHF-associated health care utilisation in patients who had recently been hospitalised. The intervention was safe. However, the sample size was small and results were not compared to a control group. Therefore, the effects of natural recovery are unknown.