Impact of supervised cardiac rehabilitation on clinical outcomes in patients with chronic lv systolic dysfunction

Abstract

Cardiac rehabilitation is increasingly being recognized as an important factor in reducing morbidity and mortality in patients with chronic LV systolic dysfunction (LVSD) due to cardiovascular disease. It is credited with improving functional capacity, reducing ischemic burden, modifying LV geometry and reducing risk of future cardiac events. We evaluated the effects of a 12-week aerobic training program in patients with significant chronic LVSD (LVEF40%). From 1/00-12/03, 606 such patients (mean age 67; 23% female) were enrolled in a supervised exercise program. The exercise prescription used a preset protocol designed by a group of exercise specialists and consisted of ECG-monitored, symptom-limited cycle ergometry and treadmill walking up to 60 minutes per session, 3 days a week. Exercise intensity was set at 60-70% of heart rate reserve. Multiple indices of exercise tolerance, LVEF and metabolic parameters were recorded at entry and at completion of cardiac rehabilitation. There were no significant complications. Conclusions: (1) Our experience demonstrates the benefits of a supervised cardiac rehabilitation program on patients with chronic LVSD. (2)There is significant improvement in LV systolic and diastolic performance, HDL and FBG levels. (3) This translates into significant improvement in functional class, resting heart rate and exercise times and intensity. Longer follow-up will determine if these promising results are sustained in the long-term and their impact on long-term survival. ∗ Results Variable Pre-Rehab Post-Rehab ‘P’ Value Weight (lb) 182.21 179.45 0.000 ∗ ‘P’ value significant at ≤0.0001; NYHA Class 2.9 2.1 0.003 ‘P’ value significant at ≤0.05; FBS:fasting blood sugar Resting HR 84.93 76.12 0.000 ∗ ‘P’ value significant at ≤0.0001; Exercise HR 98.11 90.93 0.561 Treadmill Time (min) 16.59±8.24 28.87±10.77 0.000 ∗ ‘P’ value significant at ≤0.0001; TM Workload (METS) 2.45±0.75 3.72±1.75 0.000 ∗ ‘P’ value significant at ≤0.0001; Cycle Ergometry Time (min) 6.58±3.82 20.90±3.55 0.0034 ‘P’ value significant at ≤0.05; FBS:fasting blood sugar GXT Workload (METS) 3.78±1.46 8.44±5.02 0.003 ‘P’ value significant at ≤0.05; FBS:fasting blood sugar GXT Double Product 15,225±4,566 20,533±4,245 0.000 ∗ ‘P’ value significant at ≤0.0001; LVEF (%) 31.27±7.90 39.34±11.80 0.010 ‘P’ value significant at ≤0.05; FBS:fasting blood sugar Diastolic dysfx (%) 46.1 11.8 0.001 ‘P’ value significant at ≤0.05; FBS:fasting blood sugar Total Cholesterol (mg/dL) 198.1 167.8 0.282 HDL (mg/dL) 31.95 40.89 0.000 ∗ ‘P’ value significant at ≤0.0001; LDL (mg/dL) 106.75 99.82 0.515 FBS (mg/dL) 122.33 115.06 0.010 ‘P’ value significant at ≤0.05; FBS:fasting blood sugar ∗ ‘P’ value significant at ≤0.0001; ∗∗ ‘P’ value significant at ≤0.05; FBS:fasting blood sugar Open table in a new tab