Author + information
- Basuni Radi,
- Anwar Santoso,
- Bambang B. Siswanto and
- Dede Kusmana
This study identified determinants that could influence adverse cardiac events if patients with HF participated in exercise program (EP) early after rehospitalisation.
This was a part of a quasi-experimental study which consecutively recruited patients after hospitalisation of acute decompensated heart failure, with ejection fraction (EF) < 40%, age < 65 years, resting heart rate < 100 bpm. Fourty eight subjects as the intervention group (IG) underwent supervised, three sessions per week, symptom-limited, low to moderate intensity EP early after hospitalisation, using ergocycle, walking or treadmill when possible beside usual care. Meanwhile, 65 consecutive patients with similar characteristic underwent usual care only as control group (CG). Major adverse cardiac events (MACEs) such as mortality, rehospitalisation, and clinical worsening of HF of both groups were recorded within first month.
Both groups had similar baseline characteristics regarding demography, basic rhythm, ejection fraction (EF), cause of HF, co-morbidities, HF prognosis-related laboratories, medications, and 6-minute walking (6MWT) distance. The EP was commenced at day 5.1 +/- 3.5 after hospital discharge by IG subjects. MACEs were experienced by 9 (18.8%) of IG subjects and by 26 (40%) of CG (p = 0.016). In the IG, 6MWT distance < 240 meters had adjusted RR 4.17 (95%CI: 1.08 - 16.04), p=0.038 for MACEs, but EF < 21% had RR 0.88 (95%CI: 0.24-3.27), p=0.84 for MACEs. But in the CG, 6MWT distance < 240 meters had RR 0.92 (95%CI: 0.45-1.89), p=0.814 for MACEs and EF < 21% had RR 2.35 (05%CI: 1.02-5.41), p=0.045 for MACEs.
Six-minute walking distance less than 240 meters was predictor of MACEs for patients with who participated in early EP. Patients with HF with 6MWT distance < 240 meters at discharge should be considered carefully to participate in early EP. Meanwhile, Low EF was not a limitation for early participation in EP.