Cardiovascular Outcomes Of Patients With Heart Failure Referred To Home Based Cardiac Rehabilitation

Abstract

Introduction Heart Failure (HF) patients have significant morbidity, mortality and re-hospitalizations. Home-Based cardiac rehabilitation (HBCR) can provide ideal opportunity for patients with HF to reduce hospitalizations and death. Cardiovascular outcomes in HF patients who was referred to HBCR is not known. Methods Retrospective study of 188 patients with HF (heart failure with reduced ejection fraction [HFrEF] & heart failure with preserved ejection fraction [HFpEF]) referred to HBCR at Providence VA Medical Center after IRB approval. We compared outcomes of HF patients who attended HBCR vs patients did not attend HBCR (Non-HBCR) from 3 to 12 months. HBCR consisted of face-to-face entry & exit exam, weekly phone calls and exercise prescription adjustment for 12-weeks. Primary outcome was composite of all-cause mortality and cardiovascular hospitalizations. Secondary outcomes were all-cause hospitalization, all-cause mortality and cardiovascular hospitalizations, separately. We used cox proportional methods to calculate hazard ratios (HR) and 95% CI. We adjusted for imbalanced characteristics at baseline: age, smoking, PCI and CABG status. In subgroup analysis, we compared HFrEF and HFpEF patients who have completed HBCR and compared outcome differences (weight, blood pressure, cholesterol, LDL, HDL, triglycerides, HbA1C, 6 Minutes walking test [6MWT], duke score and PHQ-9) pre and post-HBCR. Results From November 2017 to March 2020, 188 patients (mean age: 73, 98% Male) were referred to HBCR and 11 patients were excluded for the main analysis as their outcomes occurred in less than 90 days. 105/177 (59%) patients attended HBCR while 72/177 (41%) patients did not attend HBCR and 93/105 (89%) patients have completed HBCR. The primary outcome occurred in 14 patients (13.3%) in HBCR group and 19 patients (26.4%) in Non-HBCR group (adjusted HR=0.32, CI 0.15-0.68). There was no difference in cardiovascular hospitalization among two groups, however patients in HBCR group have lower all-cause hospitalizations and all-cause death, separately, between the two groups at 12 months. After HBCR completion, all outcomes (weight, blood pressure, cholesterol, LDL, HDL, triglycerides, HbA1C, 6MWT, duke score and PHQ-9) have improved in HFrEF and HFpEF group. Conclusion Completion of HBCR among HF patients was associated with a lower risk of long-term cardiovascular outcomes. HFrEF and HFpEF patients have same degree of improvement after HBCR when compared with each other. Heart Failure (HF) patients have significant morbidity, mortality and re-hospitalizations. Home-Based cardiac rehabilitation (HBCR) can provide ideal opportunity for patients with HF to reduce hospitalizations and death. Cardiovascular outcomes in HF patients who was referred to HBCR is not known. Retrospective study of 188 patients with HF (heart failure with reduced ejection fraction [HFrEF] & heart failure with preserved ejection fraction [HFpEF]) referred to HBCR at Providence VA Medical Center after IRB approval. We compared outcomes of HF patients who attended HBCR vs patients did not attend HBCR (Non-HBCR) from 3 to 12 months. HBCR consisted of face-to-face entry & exit exam, weekly phone calls and exercise prescription adjustment for 12-weeks. Primary outcome was composite of all-cause mortality and cardiovascular hospitalizations. Secondary outcomes were all-cause hospitalization, all-cause mortality and cardiovascular hospitalizations, separately. We used cox proportional methods to calculate hazard ratios (HR) and 95% CI. We adjusted for imbalanced characteristics at baseline: age, smoking, PCI and CABG status. In subgroup analysis, we compared HFrEF and HFpEF patients who have completed HBCR and compared outcome differences (weight, blood pressure, cholesterol, LDL, HDL, triglycerides, HbA1C, 6 Minutes walking test [6MWT], duke score and PHQ-9) pre and post-HBCR. From November 2017 to March 2020, 188 patients (mean age: 73, 98% Male) were referred to HBCR and 11 patients were excluded for the main analysis as their outcomes occurred in less than 90 days. 105/177 (59%) patients attended HBCR while 72/177 (41%) patients did not attend HBCR and 93/105 (89%) patients have completed HBCR. The primary outcome occurred in 14 patients (13.3%) in HBCR group and 19 patients (26.4%) in Non-HBCR group (adjusted HR=0.32, CI 0.15-0.68). There was no difference in cardiovascular hospitalization among two groups, however patients in HBCR group have lower all-cause hospitalizations and all-cause death, separately, between the two groups at 12 months. After HBCR completion, all outcomes (weight, blood pressure, cholesterol, LDL, HDL, triglycerides, HbA1C, 6MWT, duke score and PHQ-9) have improved in HFrEF and HFpEF group. Completion of HBCR among HF patients was associated with a lower risk of long-term cardiovascular outcomes. HFrEF and HFpEF patients have same degree of improvement after HBCR when compared with each other.