Cardiac rehabilitation improved LVEF, METs, VO2p, and quality of life in HFrEF patients, with greater VO2p gains in those on optimal 4-drug pharmacological treatment.
Does complete 4-pillar medical therapy combined with cardiac rehabilitation improve cardiorespiratory fitness, LVEF, and quality of life more than incomplete medical therapy with cardiac rehabilitation in patients with HFrEF?
Cardiac rehabilitation improves cardiorespiratory fitness, LVEF, and quality of life in HFrEF patients, with greater gains in maximum oxygen consumption when combined with complete 4-pillar medical therapy.
Absolute Event Rate: 0% vs 0%
Abstract Heart failure with reduced ejection fraction (HFrEF) affects cardiorespiratory fitness, quality of life (QoL), and systolic function (LVEF). Guidelines recommend cardiac rehabilitation (CR) with a solid level of evidence as a strong therapeutic indication, alongside the 4-pillar pharmacological treatment, despite their low worldwide availability. This makes us question about the impact of CR programs on reinforcing the heart failure medical treatment, with the hypothesis that this conjunction contributes to greater gains in cardiorespiratory fitness (CRFit), QoL and LVEF. The purpose of this study is to evaluate the clinical impact of CR in HFrEF in this outcomes with emphasis on optimal medical therapy. Methods: A quasi-experimental study involving 70 patients with HFrEF who underwent a 4- to 6-week CR program with concurrent training (30 mins of aerobic at 70% of their heart rate reserve plus 30 mins of strength, 3 times per week) plus nutritional and psychoemotional control, were divided into 2 groups according to the degree of tolerance, adherence and availability to medical treatment: if they had all 4 drugs (CMT, n = 35) or if they did not (NCMT, n = 35). Cardiorespiratory fitness was measured by direct VO2 at maximal exertion, LVEF by echocardiography, and quality of life (QoL) through the SF-36 questionnaire, before and after CR. Analysis was performed with Kolmogorov-Smirnov and t tests for group comparisons. Results: We rehabilitated 70 patients, 78% were male and the main etiology was ischemic (93%). In the CMT group, there were improvements (expressed as averages) in LVEF from 31.0 to 40.8% (p0.001), METs (load) from 6.4 to 12.8 (p0.001), maximum oxygen consumption (VO2p) from 17.0 to 25.4 ml/kg/min (p0.001), and CV from 71 to 85 (p0.001). In the NCMT group the gains were also significant with LVEF of 37.0 to 41.8% (p 0.001), METs of 6.7 to 10.1 (p 0.001), and CV of 71 to 79 (p 0.001), but with minor gains in VO2p of 17.4 to 21.4 ml/kg/min (p 0.001). Conclusion: CR demonstrated benefits in HFrEF, both in CRFit gains (measured by both METs-load and VO2p), QoL and LVEF, regardless of adherence to pharmacological treatment. Improvements were greater in the CMT group in VO2p. The above reinforces the fundamental role of pharmacological treatment combined with CR in this type of patient.Table 1. Image 1.
Vargas et al. (Sat,) reported a other. Cardiac rehabilitation improved LVEF, METs, VO2p, and quality of life in HFrEF patients, with greater VO2p gains in those on optimal 4-drug pharmacological treatment.