Is integrated pulmonary and heart failure rehabilitation effective and safe in primary care?

Abstract

Introduction: Integrated pulmonary rehabilitation (PR) and heart failure rehabilitation (HFR) programs have been shown to be effective in a research and hospital settings but little is known whether combining the two diseases into one rehabilitation program is safe and effective in primary care. Method: A 12-month pilot of community based integrated PR and HFR programs was established in Leicestershire for patients with either a confirmed diagnosis of COPD and a MRC score of ≥ 3 or a confirmed diagnosis of heart failure and a NYHA score of ≥ 2. 79 patients (50 males, mean age 71, age range 51-87) were recruited. The integrated rehabilitation program was set up in accordance with current national guidance with twice weekly exercise and education sessions for 6-weeks. Patients were assessed at baseline and completion of the program using the Incremental Shuttle Walk Test (ISWT), Endurance Shuttle Walk Test (ESWT), Chronic Respiratory Questionnaire (CRQ) or Chronic Heart Questionnaire, GAD7 questionnaire and PHQ9 questionnaire. Results: 63 patients completed the integrated programs with outcomes. 16 patients dropped out of the study. Significant differences were achieved in exercise capacity when compared to pre and post rehabilitation. The mean difference in the incremental and endurance shuttle walk test was 56 metres and 376 seconds respectively (P Conclusion: This pilot programme has demonstrated that the delivery of integrated PR and HFR within a community setting is safe and effective and delivers comparable outcomes to previously reported disease specific rehabilitation programs.