Randomised controlled trial of cardiac rehabilitation in elderly patients with heart failure.
BACKGROUND
Heart failure, a condition predominantly affecting the elderly, represents an ever-increasing clinical and financial burden for the NHS. Cardiac rehabilitation, a service that incorporates patient education, exercise training and lifestyle modification, requires further evaluation in heart failure management.


OBJECTIVE
The aim of this study was to determine whether a cardiac rehabilitation programme improved on the outcomes of an outpatient heart failure clinic (standard care) for patients, over 60 years of age, with chronic heart failure.


METHODS
Two hundred patients (60-89 years, 66% male) with New York Heart Association (NYHA) II or III heart failure confirmed by echocardiography were randomised. Both standard care and experimental groups attended clinic with a cardiologist and specialist nurse every 8 weeks. Interventions included exercise prescription, education, dietetics, occupational therapy and psychosocial counselling. The main outcome measures were functional status (NYHA, 6-min walk), health-related quality of life (MLHF and EuroQol) and hospital admissions.


RESULTS
There were significant improvements in MLHF and EuroQol scores, NYHA classification and 6-min walking distance (meters) at 24 weeks between the groups (p<0.001). The experimental group had fewer admissions (11 vs. 33, p<0.01) and spent fewer days in hospital (41 vs. 187, p<0.001).


CONCLUSIONS
Cardiac rehabilitation, already widely established in the UK, offers an effective model of care for older patients with heart failure.
Austin
Jacky
J
Gwent Healthcare Trust, Nevill Hall Hospital, Abergavenny, Monmouthshire, NP7 9SA, United Kingdom. jackie.austin@gwent.wales.nhs.uk
Williams
Robert
R
Ross
Linda
L
Moseley
Laurie
L
Hutchison
Stephen
S
D000368:Aged; D005081:Exercise Therapy; D005260:Female; D006333:Heart Failure / Q000534:rehabilitation* / Q000628:therapy; D006801:Humans; D008019:Life Style; D008297:Male; D008875:Middle Aged; D009722:Nurse Practitioners; D010044:Outpatient Clinics, Hospital; D010348:Patient Care Team; D010353:Patient Education as Topic; D011788:Quality of Life; D013222:State Medicine; D013997:Time Factors; D006113:United Kingdom