Heart Failure Rehabilitation Impacts Quality of Life and Readmissions: Breathlessness Rehabilitation Classes Integrating Heart Failure and Pulmonary Rehabilitation Made Positive Impact on Quality of Life, Health Literacy, and Readmissions

Abstract

Heart Failure (HF) patients often have limited exercise capacity due to dyspnoea and fatigue. Despite the availability of effective treatment, HF is associated with poor quality of life (QOL), high morbidity and mortality. Māori are twice as likely to die and four times as likely to be hospitalised for HF. Heart failure hospitalisations cost an estimated 2% to the New Zealand health system. Until the late 1980s, exercise was considered unsafe for HF; since then, considerable research evidence has suggested that exercise is safe and provides substantial physiological and psychological benefits. Whilst potential benefits are clear, there were no guidelines or resources available for HF patients in Hawkes Bay. With aim of improving functional capacity and QOL for HF patients and reduce readmissions, rehabilitation space was explored. Fiscal budgets and need of a multidisciplinary team were barriers to idealistic HF rehabilitation. The HF rehabilitation was integrated into pulmonary rehabilitation, with modification as per HF guidelines on exercise, content, and training of all staff regarding cardiology. The HF rehabilitation classes commenced in rural and urban regions (four regions in total). Patients were selected as per referral criteria and the first assessment was completed by the cardiologist/nurse practitioner/clinical nurse specialist and referred to an 8-week rehabilitation program. QOL tools were used to measure the before and after outcomes. More than 200 patients were referred and evaluated for results. Twenty-five HF patients were interviewed to understand enablers and barriers to rehabilitation. The HF patients who attended the program were almost 50% less likely to be readmitted, had reduced breathlessness, and improved fitness. Self-management skills and health literacy were also improved. Heart failure rehabilitation has proven to be a low-cost, high-value intervention, but is generally underused.