Abstract
<b>Background:</b> The purpose of this study was to investigate whether patients with adult congenital heart disease (ACHD) benefit from exercise-based cardiac rehabilitation (CR) short- and long-term with regard to improvement of cardiorespiratory fitness. <b>Methods:</b> Cardiopulmonary exercise tests (CPET) completed by ACHD patients between January 2000 and October 2019 were analysed retrospectively. Linear mixed models were performed for peak oxygen consumption (VO<sub>2</sub>) with patients as random effect and age, sex, disease classification, preceding surgery (≤3 months) and preceding CR (≤4 weeks for short term and >4 weeks for long term) as fixed effects. <b>Results:</b> 1056 CPETs of 311 ACHD patients with simple (7), moderate (188) or great (116) complexity heart defects were analysed. The 59 patients who completed a CR (median age 27 yrs, 38% females) increased peak VO<sub>2</sub> from before to after CR by a median of 2.7 (IQR –0.6 to 5.5) ml/kg/min. However, in the multivariate mixed model, peak VO<sub>2</sub> was non-significantly increased short-term after CR (β 0.8, 95%CI –0.7 to 2.4), not maintained long-term after CR (β 0.0, 95%CI –1.7 to 1.6) but significantly reduced after surgery (β –5.1, 95%CI –7.1 to –3.1). The 20 CR patients after surgery increased their peak VO<sub>2</sub> by 6.2 (IQR 3.6–9.5) ml/kg/min, while the 39 CR patients without preceding surgery increased it by 0.9 (IQR –1.5 to 3.1) ml/kg/min. <b>Conclusions:</b> The increase in peak VO<sub>2</sub> with CR was mainly due to recovery from surgical intervention. The small independent benefit from CR was not maintained long-term, highlighting the potential to improve current CR concepts in ACHD populations.
Highlights
Almost one percent of all newborns are born with a congenital heart disease (CHD) [1]
The aim of this study was to assess if cardiorespiratory fitness improved short and long-term after cardiac rehabilitation (CR) and whether this effect was independent of the recovery process from preceding surgical intervention
Reasons for excluding 385 patients are listed in (Fig. 1). 1052 Cardiopulmonary exercise tests (CPET) of 311 adult congenital heart disease (ACHD) patients (38% female) including 59 patients with CR and 252 without CR were included in the analyses (Fig. 1)
Summary
Almost one percent of all newborns are born with a congenital heart disease (CHD) [1]. Exercise intolerance is a major problem for ACHD patients, significantly restricting their quality of life [5,6], and increasing their risk for severe cardiac complications including arrhythmia and heart failure [7]. It may increase their risk for late complications such as heart failure and sudden cardiac death [8,9,10]. The purpose of this study was to investigate whether patients with adult congenital heart disease (ACHD) benefit from exercise-based cardiac rehabilitation (CR) short- and long-term with regard to improvement of cardiorespiratory fitness. The small independent benefit from CR was not maintained long-term, highlighting the potential to improve current CR concepts in ACHD populations
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