Abstract
IntroductionPatients with heart failure (HF) are now a priority group for cardiac rehabilitation (CR). A fundamental component of CR is increasing physical fitness through exercise training. Even though studies show fitness benefits, there is little evidence in routine populations of individual factors that may influence fitness. This study aims to evaluate the extent to which demographics and clinical measures predict physical fitness in patients with HF and develop reference values to guide practice. MethodsData from the National Audit Cardiac Rehabilitation (NACR) was analysed. 2047 patients (73% male) with HF completed an incremental shuttle walk test (ISWT). Backward regression accounting for patient characteristics and new comorbidity groups were used to identify predictors of distance using ISWT. Reference values were produced from the percentiles of the ISWT distance. ResultsPopulation age was 64.43 years (12.39 SD) with an average ISWT distance of 278.57 m (SD 158.57). Demographics, risk factors and comorbidities explained 26% of the variance in distance (adjusted R2 = 0.256, p value < 0.001). Diuretics (−33.01 m ±8.07 SD) and socioeconomic status (9.12 m ±2.91 SD) were significant predictors of baseline walking fitness. Furthermore, respiratory obstructions, musculoskeletal issues and metabolic diseases were associated with reduced walking distance of 29.8 m, 26.6 m and 18.4 m respectively. ConclusionUse of diuretics, socioeconomic status and presence of comorbidities were significant predictors of walking performance in patients with HF who attended CR and were fit enough to carry out an ISWT. Reference values, to aid clinical practice, were developed that included age, gender and comorbidities status.
Highlights
Patients with heart failure (HF) are a priority group for cardiac rehabilitation (CR)
IMD status was significantly associated with incremental shuttle walk test (ISWT) (p value = 0.40) indicating that there was a gradient across the quintiles, with a greater ISWT performance from the lowest quintile compared to the 2nd quintile, by an average of 19 m
HF patients who did not achieve the minimum weekly recommended amount of physical activity, those with higher Body mass index (BMI), unemployed, not in a relationship and taking diuretics were all associated with a lower ISWT score, ranging between 23 and 52 m (p 0.007 to b0.001)
Summary
Patients with heart failure (HF) are a priority group for cardiac rehabilitation (CR). Conclusion: Use of diuretics, socioeconomic status and presence of comorbidities were significant predictors of walking performance in patients with HF who attended CR and were fit enough to carry out an ISWT. Patients with HF experience marked reductions in their exercise capacity or physical fitness which has detrimental effects on their activities of daily living, health-related quality of life and their hospital admission rate and mortality [2]. In addition to their heart condition, patients with HF often have the presence of other chronic comorbidities which may further reduce their physical fitness. Based on several decades of evidence, including a recent Cochrane review [5], the
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