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Amstad T1,2, Taeymans J2, Englberger L3, Mohacsi P3, Wilhelm M4, Steiner D5, Hermann M1,4
1Zürcher RehaZentrum Wald, Wald, Switzerland, 2Bern University of Applied Sciences, Departement of Health Professions, Berne, Switzerland, 3Inselspital Bern, Berne, Switzerland, 4UniversityHospital Zurich, Zurich, Switzerland, 5Berner Reha Zentrum Heiligenschwendi, Heiligenschwendi, Switzerland
Background: Ventricular assist devices (VAD) are increasingly implanted in patients with end-stage heart failure in Switzerland. Since 2007, these patients are regularly referred to in-patient cardiac rehabilitation (CR), but studies about the effect of CR in patients with VAD in Switzerland are lacking.
Purpose: Therefore, the aim of this study was to investigate the changes in functional capacity (FC) and quality of life (QoL) during CR of patients with VAD as well as to explore associations between CR entry measures and the outcomes mortality, length of stay (LoS) in CR and referrals to acute care during CR.
Methods: Data on 110 patients (mean age = 53; males = 82%) with VAD-implantation between 01.01.2007 and 31.03.2017 at the Inselspital Berne or the UniversityHospital Zurich with subsequent CR at the Berner Reha Zentrum Heiligenschwendi or the Zürcher RehaZentrum Wald was analysed retrospectively. CR measures of FC (6-Minutes Walking Distance (6MWD), Functional Independence Measure (FIM) and Ergometry) as well as QoL (Mac New Heart Disease Questionnaire (MNH) and Hospital Anxiety and Depression Scale (HADS)) at entry and discharge were examined using dependent samples t-test or Wilcoxon signed-rank test according to level of scale of the variables and fulfilment of assumptions. Associations of CR entry measures with outcomes was analysed with Pearson's or Spearman's correlation as appropriate. Significance was set at a level of α = 0.05.
Results: Patients with VAD improved during CR significantly in 6MWD (mean 114 ± 85 meters, p 0.001), Ergometry (mean 20 ± 17 Watt, p = 0.002), FIM (median 6 points, p 0.001) and MNH (median 0.69 points, p 0.001), but not in HADS (median -1 point, p = 0.637). The changes in 6MWD and MNH were also clinically relevant. Small to moderate significant negative correlations of 6MWD (r = -0.23, p = 0.038), FIM (r = -0.46, p 0.001) and HADS (r = 0.39, p = 0.013) at entry with mortality, FIM at entry with LoS in CR (r = -0.27, p = 0.015), as well as FIM (r = -0.27, p = 0.014) and MNH (r = -0.26, p = 0.037) at entry with referral to acute care were found.
Conclusion(s): Patients with VAD showed improvements in FC and QoL during CR, but since this study was a retrospective analysis without control group, it cannot be determined if the progress was due to CR or the implantation of the VAD. However, several studies found greater changes in FC and QoL in patients with VAD who underwent CR compared to controls.
Implications: The referral of patients with VAD to CR can be justified by current evidence. The remaining high values of HADS during CR in patients with VAD should receive more attention in clinical practice since depression is a risk factor for infections and leads to a higher mortality. The associations of CR measures at entry with late outcomes could be further investigated to determine predictors.
Keywords: ventricular assist device, cardiac rehabilitation, exercise
Funding acknowledgements: Fees for the ethics committee were paid by the research fund of the Zürcher RehaZentrum Wald, Switzerland.
Purpose: Therefore, the aim of this study was to investigate the changes in functional capacity (FC) and quality of life (QoL) during CR of patients with VAD as well as to explore associations between CR entry measures and the outcomes mortality, length of stay (LoS) in CR and referrals to acute care during CR.
Methods: Data on 110 patients (mean age = 53; males = 82%) with VAD-implantation between 01.01.2007 and 31.03.2017 at the Inselspital Berne or the UniversityHospital Zurich with subsequent CR at the Berner Reha Zentrum Heiligenschwendi or the Zürcher RehaZentrum Wald was analysed retrospectively. CR measures of FC (6-Minutes Walking Distance (6MWD), Functional Independence Measure (FIM) and Ergometry) as well as QoL (Mac New Heart Disease Questionnaire (MNH) and Hospital Anxiety and Depression Scale (HADS)) at entry and discharge were examined using dependent samples t-test or Wilcoxon signed-rank test according to level of scale of the variables and fulfilment of assumptions. Associations of CR entry measures with outcomes was analysed with Pearson's or Spearman's correlation as appropriate. Significance was set at a level of α = 0.05.
Results: Patients with VAD improved during CR significantly in 6MWD (mean 114 ± 85 meters, p 0.001), Ergometry (mean 20 ± 17 Watt, p = 0.002), FIM (median 6 points, p 0.001) and MNH (median 0.69 points, p 0.001), but not in HADS (median -1 point, p = 0.637). The changes in 6MWD and MNH were also clinically relevant. Small to moderate significant negative correlations of 6MWD (r = -0.23, p = 0.038), FIM (r = -0.46, p 0.001) and HADS (r = 0.39, p = 0.013) at entry with mortality, FIM at entry with LoS in CR (r = -0.27, p = 0.015), as well as FIM (r = -0.27, p = 0.014) and MNH (r = -0.26, p = 0.037) at entry with referral to acute care were found.
Conclusion(s): Patients with VAD showed improvements in FC and QoL during CR, but since this study was a retrospective analysis without control group, it cannot be determined if the progress was due to CR or the implantation of the VAD. However, several studies found greater changes in FC and QoL in patients with VAD who underwent CR compared to controls.
Implications: The referral of patients with VAD to CR can be justified by current evidence. The remaining high values of HADS during CR in patients with VAD should receive more attention in clinical practice since depression is a risk factor for infections and leads to a higher mortality. The associations of CR measures at entry with late outcomes could be further investigated to determine predictors.
Keywords: ventricular assist device, cardiac rehabilitation, exercise
Funding acknowledgements: Fees for the ethics committee were paid by the research fund of the Zürcher RehaZentrum Wald, Switzerland.
Topic: Cardiorespiratory; Disability & rehabilitation
Ethics approval required: Yes
Institution: Canton Zurich
Ethics committee: Cantonal Ethics Committee Zurich and Berne
Ethics number: BASEC-Nr. 2017-00747
All authors, affiliations and abstracts have been published as submitted.
