Abstract
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.
Highlights
Heart failure (HF), is a leading cause of cardiovascular morbidity and mortality in Sub-Saharan Africa
Cardiac rehabilitation (CR) is a multidisciplinary approach providing physical, psychological and social support to patients recovering from cardiac illnesses such as HF
We report crude differences in mean 6-minute walk time distance (6MWTD) and not means adjusted for possible covariate imbalance across arms because, a priori, we did not consider possible confounders of the treatment effect and adjustment for covariates observed to be imbalanced would have likely led to residual confounding
Summary
Heart failure (HF), is a leading cause of cardiovascular morbidity and mortality in Sub-Saharan Africa. 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. Low and middle income countries account for over 80% of global cardiovascular disease mortality [2], with heart failure (HF) manifesting as a terminal complication. There are two common models for delivering CR: institution-based cardiac rehabilitation (IBCR), and home-based cardiac rehabilitation (HBCR). IBCR and HBCR models are similar in efficacy, and to have comparable low risk profiles [7, 8]
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