Can a heart failure-specific cardiac rehabilitation program decrease hospitalizations and improve outcomes in high-risk patients?
BACKGROUND
Heart failure is a common and costly condition, particularly in the elderly. A range of models of interventions have shown the capacity to decrease hospitalizations and improve health-related outcomes. Potentially, cardiac rehabilitation models can also improve outcomes.


OBJECTIVE
To assess the impact of a nurse-coordinated multidisciplinary, cardiac rehabilitation program to decrease hospitalizations, increase functional capacity, and meet the needs of patients with heart failure.


METHODS
In a randomized control trial, a total of 105 patients were recruited to the study. Patients in the intervention group received an individualized, multidisciplinary 12-week cardiac rehabilitation program, including an individualized exercise component tailored to functional ability and social circumstances. The control group received an information session provided by the cardiac rehabilitation coordinator and then follow-up care by either their cardiologist or general practitioner. This trial was stopped prematurely after the release of state-based guidelines and funding for heart failure programs.


RESULTS
During the study period, patients in the intervention group were less likely to have been admitted to hospital for any cause (44 vs. 69%, P = 0.01) or after a major acute coronary event (24 vs. 55%, P = 0.001). Participants in the intervention group were more likely to be alive at 12 months, (93 vs. 79%; P = 0.03) (odds ratio = 3.85; 95% confidence interval=1.03-14.42; P = 0.0042). Quality of life scores improved at 3 months compared with baseline (intervention t = o/-4.37, P<0.0001; control t = /-3.52, P<0.01). Improvement was also seen in 6-min walk times at 3 months compared with baseline in the intervention group (t = 3.40; P = 0.01).


CONCLUSIONS
This study shows that a multidisciplinary heart failure cardiac rehabilitation program, including an individualized exercise component, coordinated by a specialist heart failure nurse can substantially reduce both all-cause and cardiovascular readmission rates, improve functional status at 3 months and exercise tolerance.
Davidson
Patricia M
PM
Curtin University of Technology, 39 Regent Street, Chippendale, NSW 2008, Australia. p.davidson@curtin.edu.au
Cockburn
Jill
J
Newton
Phillip J
PJ
Webster
Julie K
JK
Betihavas
Vasiliki
V
Howes
Laurie
L
Owensby
Dwain O
DO
D000368:Aged; D016009:Chi-Square Distribution; D003376:Counseling; D005081:Exercise Therapy; D017079:Exercise Tolerance; D005260:Female; D006333:Heart Failure / Q000401:mortality / Q000451:nursing / Q000503:physiopathology / Q000534:rehabilitation*; D006760:Hospitalization; D006801:Humans; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009517:New South Wales; D016017:Odds Ratio; D010044:Outpatient Clinics, Hospital; D010348:Patient Care Team; D010359:Patient Readmission; D011788:Quality of Life; D020127:Recovery of Function; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome