Cardiac Rehabilitation in Adult Congenital Heart Disease

Introduction and Aims Adults with congenital heart disease (ACHD) are a growing population with distinct functional limitations and psychosocial needs. While cardiac rehabilitation is well established in acquired heart disease, its role in ACHD remains underexplored. We aimed to evaluate the safety and effectiveness of cardiac rehabilitation in ACHD. Primary outcomes included program safety, exercise capacity, quality of life (QoL) and mental health effects. Methods Data were collected from a tertiary centre from 1994-2024. The ESC ACHD lesion classification was used. Exercise capacity was assessed by treadmill graded exercise testing (METs) or 6-minute walk test (6MWT). QoL and mental health impacts were measured using Short Form 36 (SF-36) and Depression Anxiety Stress Scales-21 (DASS-21) questionnaires. Results In 219 people with ACHD aged 50.2±16.5 years (23.4% female), 43% had simple, 51% moderate and 6% complex CHD. Peak exercise capacity increased after cardiac rehabilitation with treadmill tests increasing by 3.0 METs (95%CI, 2.7–3.3, p<0.05) and 6MWT by 75.1 metres (95%CI, 46.7–103.5, p<0.05). SF-36 scores improved across all domains, with the most points gained in role limitations due to physical health (+45.0, 95%CI, 38.5–51.5, p<0.05) and physical functioning (+23.0, 95%CI: 19.9–26.1, p<0.05). DASS-21 scores also improved notably anxiety (+2.4, 95%CI, 1.3–3.4, p<0.05), depression (+1.6, 95% CI, 0.48–2.7 p<0.05), and stress (+1.7, 95%CI, 0.6–2.8, p<0.05). Subgroup analyses demonstrated no effect of ACHD severity or lesion types on outcomes. There were no adverse events. Conclusion Cardiac rehabilitation in ACHD did not lead to adverse events and produced improvements in peak exercise capacity and patient-reported outcomes, regardless of lesion type or severity.