Article

There are limited contemporary data regarding the association
between improvement in cardiovascular fitness in heart failure patients who
participate in a cardiac rehabilitation programme and the risk of subsequent
hospitalisations. Methods The study population comprised 421 patients with heart
failure who participated in our cardiac rehabilitation programme between the
years 2009 and 2016. All were evaluated by a standard exercise stress test before
initiation, and underwent a second exercise stress test on completion of 3 +/- 1
months of training. Participants were dichotomised by fitness level at baseline,
according to the percentage of predicted age and sex norms achieved. Each group
was further divided according to its degree of functional improvement, between
the baseline and the follow-up exercise stress test. Major improvement was
defined as improvement above the median value in each group. The combined primary
endpoint was cardiac hospitalisation or all-cause mortality. Results A total of
211 (50%) patients had low baseline fitness (<73% (median)) for age and
sex-predicted metabolic equivalents of task value. Compared to patients with
higher fitness, those with a low baseline fitness were more commonly smokers, had
diabetes and were obese ( P < 0.05 for all). Multivariable Cox proportional
hazard regression analysis showed that, independent of baseline capacity, an
improvement of 5% of predicted fitness was associated with a corresponding 10%
reduced risk of cardiac hospitalisation or all-cause mortality ( P < 0.001).
Conclusion In heart failure patients participating in a cardiac rehabilitation
programme, improved cardiovascular fitness is associated with reduced mortality
or cardiac hospitalisation risk during long-term follow-up, independent of
baseline fitness.

Langue : ANGLAIS