M. Saitoh1,2, Y. Takahashi3,4, D. Okamura4, M. Akiho5, Y. Yamaguchi6, K. Hori2, T. Takahashi1
1Juntendo University, Department of Physical Therapy, Faculty of Health Science, Tokyo, Japan, 2Sakakibara Heart Institute, Department of Rehabilitation, Tokyo, Japan, 3Juntendo University, Graduate School of Medicine, Tokyo, Japan, 4St. Luke’s International Hospital, Department of Rehabilitation, Tokyo, Japan, 5Mitsui Memorial Hospital, Department of Rehabilitation, Tokyo, Japan, 6Ayase Heart Hospital, Department of Rehabilitation, Tokyo, Japan
Background: Ambulatory cardiac rehabilitation (CR) plays an important role in management of heart failure (HF) and affects patients outcome. However, current standard ambulatory CR programs do not account for very older patients after discharge for acute decompensated HF (ADHF), because conventional exercise-based CR trials have excluded these patients.
Purpose: The object of this study was to determine the association between ambulatory CR and HF-hospital readmission and mortality in older patients after discharged for ADHF.
Methods: This cohort study examines participants enrolled in the CRAFTSMAN registry, a prospective, multicenter cohort study of consecutive patient admitted acute decompensated heart failure (ADHF) and who referred for in-hospital CR, between 2015 and 2017. For the current analysis, older patients aged 65 years and older were included. The association between ambulatory CR program attendance and HF-hospital readmission or all-cause mortality was assessed by Cox regression models in a 1:1 propensity score-matched cohort and in prespecified subgroup. This study was conducted based on the Helsinki Declaration and the Japanese Ethical Guidelines for Clinical Studies. The study protocol was approved by the ethics committee at Sakakibara Heart Institute (ID: 11-042) and the committees at each participation facility. Informed consent was obtained in the form of opt-out on the website of each hospital.
Results: Of 1941 eligible older patients with HF, only 136 (7%) participated in the ambulatory CR program. After matching, 122 ambulatory CR attendees were compared with 122 non-attendees. Ambulatory CR was associated with a reduction in all-cause mortality risk (hazard ratio ［HR］ 0.490, 95% confidence interval ［CI］0.255-0.939), whereas no difference in HF-hospital readmission was found between the 2 groups (HR 0.796, 95%CI 0.526-1.204). In additional analyses, results were consistent in subgroups including those left ventricular ejection fraction (LVEF) <40% versus LVEF ≥40%.
Conclusion(s): Among older patients with HF, ambulatory CR program participation is associated with improved all-cause and cardiovascular mortality but was not associated with HF-hospital readmission. These results call for better implementation of ambulatory CR program participation among older patients with HF.
Implications: Our findings suggests that ambulatory CR plays an important role for in the disease management among older patients after discharged for ADHF. All patients should be referred to an ambulatory CR program after hospitalization for ADHF, regardless of the presence or absence of systolic LV dysfunction.
Funding, acknowledgements: This research received no specific grant from any funding agency.
Keywords: heart failure, cardiac rehabilitation, mortality
Topic: Cardiorespiratory
Did this work require ethics approval? Yes
Institution: Sakakibara Heart Institute
Committee: Ethics committee at Sakakibara Heart Institute
Ethics number: ID: 11-042
All authors, affiliations and abstracts have been published as submitted.
