Elsevier

JACC: Heart Failure

Volume 2, Issue 6, December 2014, Pages 653-659
JACC: Heart Failure

Clinical Research
Cardiac Rehabilitation Improves Functional Capacity and Patient-Reported Health Status in Patients With Continuous-Flow Left Ventricular Assist Devices: The Rehab-VAD Randomized Controlled Trial

https://doi.org/10.1016/j.jchf.2014.06.011Get rights and content
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Abstract

Objectives

This study examined the effects of a cardiac rehabilitation (CR) program on functional capacity and health status (HS) in patients with newly implanted left ventricular assist devices (LVADs).

Background

Reduced functional capacity and HS are independent predictors of mortality in patients with heart failure. CR improves both, and is related to improved outcomes in patients with heart failure; however, there is a paucity of data that describe the effects of CR in patients with LVADs.

Methods

Enrolled subjects (n = 26; 7 women; age 55 ± 13 years; ejection fraction 21 ± 8%) completed a symptom-limited cardiopulmonary exercise test, the Kansas City Cardiomyopathy Questionnaire (KCCQ), a 6-min walk test (6MW), and single-leg isokinetic strength test before 2:1 randomization to CR versus usual care. Subjects in the CR group underwent 18 visits of aerobic exercise at 60% to 80% of heart rate reserve. Within-group changes from baseline to follow-up were analyzed with a paired t-test, whereas an independent t-test was used to determine differences in the change between groups.

Results

Within-group improvements were observed in the CR group for peak oxygen uptake (10%), treadmill time (3.1 min), KCCQ score (14.4 points), 6MW distance (52.3 m), and leg strength (17%). Significant differences among groups were observed for KCCQ, leg strength, and total treadmill time.

Conclusions

Indicators of functional capacity and HS are improved in patients with continuous-flow LVADs who attend CR. Future trials should examine the mechanisms responsible for these improvements, and if such improvements translate into improved clinical outcomes. (Cardiac Rehabilitation in Patients With Continuous Flow Left Ventricular Assist Devices:Rehab VAD Trial [RehabVAD]; NCT01584895)

Key Words

cardiopulmonary exercise testing
cardiac rehabilitation
end-stage heart failure
exercise training
Kansas City Cardiomyopathy Questionnaire
left ventricular assist device

Abbreviations and Acronyms

6MW
6-min walking distance
CPX
cardiopulmonary treadmill test
CR
cardiac rehabilitation
HF
heart failure
HS
health status
KCCQ
Kansas City Cardiomyopathy Questionnaire
LVAD
left ventricular assist device
UC
usual care
VO2
peak oxygen uptake

Cited by (0)

This study was supported by an internal grant from the Edith and Benson Ford Heart and Vascular Institute. The authors have reported that they have no relationships relevant to the contents of this paper to disclose.