Adult Congenital Heart Disease Patient Participation in a Traditional Cardiac Rehabilitation Program

Due to advancements in the treatment of individuals born with congenital heart disease, 90% will now reach adulthood. Patients with adult congenital heart disease (ACHD) suffer from low exercise capacity, which results in increased risk for hospitalization and mortality. Cardiac rehabilitation (CR) is a comprehensive outpatient disease management program that improves exercise capacity. PURPOSE: To examine the effects of CR participation, specifically program adherence, exercise capacity, treadmill walking time and adverse events among ACHD patients who participated in a non-modified traditional CR program. METHODS: The CR program offers 32 sessions of ACSM guideline-based supervised exercise. The charts of all enrolled ACHD patients were retrospectively reviewed. Graded exercise test results and treadmill walking time pre and post CR, as well as adverse events related to exercise participation were extracted. Results were described and a repeated-measures t-test was performed to assess change from pre to post-CR. Ten ACHD patients were referred to CR from 2005-2010; 4 patients had repair for defects of great complexity (pulmonary atresia; complete transposition of the great arteries; Eisenmenger syndrome; congenitally corrected transposition of the great arteries), and 6 had repair for defects of moderate complexity (tetralogy of Fallot [n=2]; atrioventricular septal defect with severe pulmonary hypertension; coarctation of the aorta; bioprosthetic valve [n=1 aortic, n=1 aortic and mitral] replacements). RESULTS: Six (60%) of patients attended the full 32 sessions of CR and reasons for non-completion were unrelated to ACHD diagnosis. Exercise capacity on the graded exercise tests improved in all patients who completed the program (8.33±1.09 vs. 9.33±0.99 Mets, p<0.05, n=6). Treadmill walking time in CR from the first to the last session improved (8.9±0.5 minutes vs. 19.4±0.6 minutes, p<0.05, n=10) in all patients whether they completed the full CR program or not. There were no reports of adverse events during CR participation despite 60% incidence of prior atrial and/or ventricular arrhythmias. CONCLUSION: Participation in CR was safe and resulted in significantly increased exercise capacity for this selected group of adults with congenital heart disease.