Cardiac rehabilitation for heart failure and atrial fibrillation: a propensity- matched study

Munyra Alhotye; Rachael A Evans; G. André Ng; Sally Singh

doi:10.1136/openhrt-2023-002372

August 1, 2023Open HeartOpen Access

Cardiac rehabilitation for heart failure and atrial fibrillation: a propensity- matched study

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Why the study?

Evidence supports exercise training in heart failure, but data on the effectiveness of comprehensive cardiac rehabilitation in individuals with coexisting heart failure and atrial fibrillation are lacking.

Does comprehensive cardiac rehabilitation improve exercise capacity and quality of life in individuals with coexisting HF and AF similarly to those with HF alone?

Structured PICO

Does comprehensive cardiac rehabilitation improve exercise capacity and quality of life in individuals with coexisting HF and AF similarly to those with HF alone?

P

Population

Individuals with heart failure (HF) and atrial fibrillation (AF), propensity matched to those with HF and no coexisting AF. Mean left ventricular ejection fraction 35.2±9.8%, 56% male.

I

Intervention

Comprehensive cardiac rehabilitation (CR)

C

Comparator

Individuals with HF and no coexisting AF undergoing comprehensive cardiac rehabilitation

O

Outcome

Change in incremental shuttle walking test, Heart Disease Quality of Life questionnaire, and Hospital Anxiety and Depression Scores pre-CR and post-CRpatient reported

Cardiac rehabilitation provides similar improvements in exercise capacity and quality of life for heart failure patients regardless of the presence of coexisting atrial fibrillation.

Implication

Cardiac rehabilitation may yield similar gains in HF regardless of AF; leaves open randomized confirmation of equivalence.

Abstract

BACKGROUND: Atrial fibrillation (AF) is common in individuals with heart failure (HF). Individuals with HF and AF may have a reduced functional capacity and quality of life (QoL) which leads to hospital admission and burden on clinical services. Evidence supported the effect of exercise training in individuals with HF. However, there is no existing data on the effectiveness of comprehensive cardiac rehabilitation (CR) in individuals with coexisting HF and AF. AIM: To explore the effect of CR in individuals with HF and AF compared with those with HF and no-coexisting AF. METHODS: Using CR database, individuals with HF and AF were identified and propensity matched to those with no coexisting AF. The change in incremental shuttle walking test, Heart Disease Quality of Life questionnaire, Hospital Anxiety and Depression Scores were compared between groups pre-CR and post-CR. RESULTS: , left ventricular ejection fraction 35.2±9.8% and 56% were male.A statistically significant improvements in exercise capacity, heart disease QoL, anxiety and depression scores were observed within each group. There were no significant differences between groups for any of these outcome measures. CONCLUSIONS: Individuals with HF and AF gain a similar improvement in exercise capacity and health related QoL outcomes as individuals with no coexisting AF following CR. The presence of AF did not compromise the effectiveness of CR.