Cardiac rehabilitation improves quality of life and walking tolerance in elderly patients with heart failure

QuestionFor patients over 60 years of age with heart failure, does cardiac rehabilitation improve outcomes over standard care at a heart failure clinic?DesignRandomised controlled trial with concealed allocation and blinded assessors.SettingParticipants were recruited from the acute medical unit and outpatient clinics of a UK hospital and surrounding general practices.PatientsPatients over 60 years of age with New York Heart Association (NYHA) class II or III heart failure and left ventricular systolic dysfunction (ejection fraction ≤ 40%). Exclusion criteria included diastolic dysfunction and significant co-morbidities. Thirty-five eligible patients refused to participate. The remaining 200 were randomised to cardiac rehabilitation (n = 100) or standard care (n = 100).InterventionsPatients in both groups received outpatient monitoring of their clinical status every eight weeks for 24 weeks, an explanation of heart failure, advice regarding diet and self-monitoring for fluid overload, and a record of their medications, test results, and appointments. During the first eight weeks, the cardiac rehabilitation group also attended twice weekly classes for aerobic and low resistance strength training, and educational input on medication, diet and exercise. For the latter 16 weeks, this group attended community-based exercise classes weekly. This group also received transport to the classes if necessary, encouragement to exercise an additional three times per week at home, and written materials.OutcomesNYHA classification and the Minnesota living with heart failure (MLHF) questionnaire were assessed at baseline, eight and 24 weeks. The six minute walk test (6MWT) and the EuroQol questionnaire were assessed at baseline and 24 weeks. Hospital admissions due to heart disease were also recorded.ResultsChange in NYHA classification was significantly better in the cardiac rehabilitation group than the control group at eight weeks (Mann-Whitney test, p = 0.001) and at 24 weeks (p < 0.001). The cardiac rehabilitation group was significantly better than the control group on the MLHF score at 8 weeks (13 points, 95% CI 7 to 19) and at 24 weeks (14 points, 95% CI 8 to 20). The cardiac rehabilitation group was also significantly better than the control group on the 6MWT (68 m, 95% CI 33 to 102) and the EuroQol score (12 points, 95% CI 7 to 17). Hospital admissions (p < 0.01) and days in hospital (p < 0.001) were also significantly fewer in the cardiac rehabilitation group.ConclusionFor patients over 60 years with heart failure cardiac rehabilitation provides important benefits over outpatient clinic care