Abstract
ObjectivesExercise-based cardiac rehabilitation (CR) is an effective intervention for patients with heart failure (HF), in which one of the main targets is to increase physical capacity. In the HF population this is traditionally assessed using distance covered during a walking test. This study aims to establish the extent to which change in walking ability, in HF patients attending CR, is determined by patient characteristics and service provision. MethodsThe study utilised routine clinical data from the National Audit of Cardiac Rehabilitation to perform a robust analysis. Change, in metres, between pre- and post-CR six-minute walk tests was calculated. Multivariate linear regression models were used to explore the relationship between patient characteristics, service-level variables, and change in metres walked. ResultsComplete and valid data from 633 patients was analysed, and a mean change of 51.30 m was calculated. Female gender (−34.13 m, p = 0.007), being retired (−36.41 m, p = 0.001) and being married/in a relationship (−32.54 m, p = 0.023) were all significant negative predictors of change. There was an additional negative relationship with body mass index (BMI) whereby for every unit increase in BMI, predicted change reduces by 2.48 m (p = 0.006). ConclusionsThis study identified significant patient-level characteristics strongly associated with limited improvement in walking ability following CR. Improving physical capacity is a core component of CR, therefore services should aim to account for baseline characteristics identified in this study as part of tailoring the CR intervention around the individual. Pre- and post-CR physical capacity assessments, which constitute minimum standards for CR, are worryingly low and should be given high priority.
Highlights
Cardiac Rehabilitation (CR) is a clinically effective intervention for patients with Heart Failure (HF) with published clinical guidance for implementation of an exercise-based rehabilitation programme [1,2,3]
Smoking status was the only variable that was omitted from the original model as descriptive statistics revealed that only 5% of the population identified as current smokers, which was too small a number for the regression model to operate
This study revealed that having a psychologist involved in CR delivery had a significant positive influence on the patients' change in walking ability, with a positive correlation between the psychologist's contracted number of hours, and the size of the change
Summary
Cardiac Rehabilitation (CR) is a clinically effective intervention for patients with Heart Failure (HF) with published clinical guidance for implementation of an exercise-based rehabilitation programme [1,2,3]. A summary of clinical trials on exercise-based CR in HF confirms a reduced risk of overall and HF-specific hospitalisation with clinically important improvement in the quality of life [1]. Data from the UK National Heart Failure Audit suggests that 7% to 20% of patients with a diagnosis of HF are referred to CR from either general wards or cardiology wards with wide variation in referrals between hospitals. Survival analysis of patients with HF, based on referral to CR, demonstrated improvements of 12% compared to patients not referred to CR [5]
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
