A RANDOMIZED TRIAL OF CARDIAC REHABILITATION FOR ADOLESCENTS AND ADULTS WITH CONGENITAL HEART DISEASE
Cardiac rehabilitation (CR) programs improve exercise capacity and quality of life while reducing mortality in adults with acquired heart disease. These programs have not been extensively studied in adults with congenital heart disease (CHD).
We performed a prospective, randomized, controlled trial (NCT01822769) of a standardized 12 wk clinical CR program including exercise training and education compared with standard-of care (SOC). Patients enrolled had moderately or severely complex CHD >15yo with resting O2 saturation >91% and peak O2 consumption (VO2pk) <80% predicted. We assessed exercise capacity, rebreathing cardiac output, quality of life, self reported health status, and other variables at baseline and after 3 months. Data are presented as mean between group differences from baseline to 3 months.
We enrolled 28 subjects (mean age 41.1±12.1y, 50% male), with 13 randomized to CR and 15 to SOC. BMI averaged 28.0±3.8kg/m2 with VO2pk=16.8±3.8 ml/kg/min, peak work rate=95±28W and median Minnesota Living with Heart Failure Questionnaire (MLHFQ) score =27 [IQR 11-44]. CR subjects were older (48±9 v 36±12y, p=0.01) but there were no significant between group differences in sex, height, weight, VO2pk, peak work rate, cardiac output, MLHFQ score or other variables. There were no adverse events related to CR. Those assigned to CR lost weight over the intervention relative to SOC (-2.3kg, p<0.03). VO2pk increased in the CR group compared with SOC (+2.2 mL/kg/min, 95%CI 0.7-3.7, p=0.002, age adjusted +2.7 mL/kg/min, p=0.004; absolute increase 119 mL/min, p=0.01); there was also a non-significant improvement in work rate (+8.1W, p=0.13) and MLHFQ score (-6.5, p=0.13). Among n=25 with baseline MLHFQ >5, there was a clinically important >5 point decrease in 72.7% of CR subjects compared with 28.6% of SOC subjects, p=0.047). Patients in the CR group also had greater improvement in a visual analogue scale self-assessment of overall health (p<0.04)
CR is safe in adults with CHD and is associated with improvement in aerobic capacity and self-reported health status compared with SOC. Further studies should evaluate the longer term effects of CR in adults with CHD.
Autor / Fonte:Alexander R. Opotowsky; Jonathan Rhodes; Lilamarie Moko; et al. J Am Coll Cardiol. 2016;67(13_S):987-987. doi:10.1016/S0735-1097(16)30988-3.