Effectiveness of comprehensive outpatient cardiac rehabilitation among heart failure patients in a developing country

Abstract Background Heart failure (HF) is a major healthcare burden in developing countries today and is only expected to worsen with the rising aging population. Comprehensive cardiac rehabilitation (CR) has been shown to reduce mortality and morbidity by minimising disease progression and enhancing exercise capacity and quality of life. However, its effectiveness in outpatient settings in developing countries remains under-reported. Purpose This study aims to evaluate the effectiveness of comprehensive outpatient CR on clinical, functional and quality of life (QoL) parameters in HF patients. Methods This retrospective study included all patients with heart failure with mildly reduced ejection fraction (HFmrEF) and reduced ejection fraction (HFrEF) completing a comprehensive outpatient cardiac rehabilitation program at our centre between 2014 and 2025. Cardiovascular risk factors, body mass index (BMI), 6-minute walk distance (6MWD) and left ventricular ejection fraction (LVEF) were documented in all subjects at baseline. Physical and mental component score (PCS/MCS) of QoL were analysed using online SF-12 questionnaire in HBCR group. Post-program LVEF was documented, when available. A multidisciplinary team comprising a physician, physiotherapist, dietitian and counseling psychologist delivered the CR program, either as centre-based (CBCR) or home-based/hybrid (HBCR) using tele-health platforms. Participants attended two to three sessions per week, combining multicomponent exercise with dietary guidance, health education and psychosocial counselling. Results The study subjects (n=53) were 89% male, 56±13 years, 96% coronary artery disease patients, 66% HFmrEF, 61% COVID-19 pandemic onward enrolments and 60% HBCR (Table 1). Overweight/obesity, hypertension and type 2 diabetes mellitus were equally prevalent in 50% subjects followed by dyslipidemia (35%) and current tobacco use (15%). Upon CR completion, significant improvement (Figure 1) was documented in 6MWD (390±99,455±106,p=0.0001), LVEF (40±5,47±10,p=0.0001), PCS (37±9,45±6,p=0.0052) and MCS (47±7,52±7,p=0.019). No adverse events were reported in either of the groups. Six (11%) subjects had died during follow-up. They were noted to be older at presentation than the surviving subjects (72±8,55±13,p=0.003). Conclusions Participation in a comprehensive CR program is associated with improvement in exercise capacity, cardiac function and QoL of HF patients with home-based being non-inferior to centre-based CR. These findings highlight the role of CR as a feasible and effective adjunct to standard HF management, warranting larger prospective studies in developing countries.For image description, please refer to the figure legend and surrounding text. For image description, please refer to the figure legend and surrounding text.