The long term impact of home based cardiac rehabilitation protocols on heart failure patients

Introduction Cardiac rehabilitation is a pillar treatment in heart failure. Home based cardiac rehabilitation protocols are emerging and attractifs since they proved short and mid term improvment on quality of life, adherence to treatment, to physical activity, and exercise capacity, but little is known about the long term effect. Aims To evaluate the long-term impact of a home-based cardiac rehabilitation protocol on 6MWT, quality of life and adherence to regular physical activity. Methods We prospectively included patients with confirmed chronic heart failure, between 01/10/2023 and 30/10/2024, in a single-center, open-label, randomized controlled trial. All patients were evaluated and received an initial individualized education on chronic heart failure and the benefit of regular exercice (Walking 30mn/day), with the help of a mother tongue leaflet. Patient were randomized at inclusion to either be encouraged for daily walk or not, with additional regular phone calls over 6 months. Over the next 6 months we sotpped the extra stimulating calls. We compared results before and after 6 months and at one year: the adherence to regular day walking, the efforts’capacity 6 minutes-walk test (6MWT)), and the quality of life (QoL) according to the Minnesota enquiry. Results A total of 109 patients has been enrolled, 73 in the initially stimulated group and 36 in the nonstimulated group. Both groups were similar for almost criteria; males in 80.7% ,mean age was 61.5+/- 8.7 Years old. Comorbidities were diabetes in 53.5%, hypertension in 50%, obesity in 21.2%, obstructive sleep apnea syndrome in 25.5%, coronary artery disease in 86.9%, arythmia in 12%. Baseline sedentarity in 60% of cases. Mean ejection fraction was 35.9% +/- 10.9. baseline mean 6MWT was 288+/-135m and Minnesota QoL-score was 31.48 +/- 17.8. At 6 months, all patients significantly enhanced the 6MWT ( 298.8 +/-132.2m; Vs 321.5+/-129.7m; p<0.0001, with better result in the stimulated group (p=0.047). At one year, 68.2% of patients declared maintaining the habit of walking; but the 6MWT enhancement was not statistically significant ( 300.9 Vs 351.4; p=0.98) while the Qol score were significantly better at one year ( 31.7 vs 28.5; p<0.0001). the stimulated group showed better mean enhancement but staistically significant only in the Qol scores variation. Conclusion Home based cardiac rehabilitation was effective to enhance 6MWT and quality of life, with a good mid and long term adherence to physical activity. However, withholding the stimulating phone calls resulted in a possible loss of benefit. Further research is needed to determine feasable and well structered ambulatory cardiac rehabilitation.