Characteristics, Therapeutic Needs, and Scope of Patients With a Continuous-Flow Left Ventricular Device Entering Cardiac Rehabilitation: A RETROSPECTIVE ANALYSIS.

BACKGROUND: With an increasing number of left ventricular assist devices (LVADs) being implanted, the need for adequate cardiac rehabilitation (CR) regimens meeting the special needs of these patients arises. Only a few studies have reported experience gained on this topic. Structured CR strategies are poorly implemented. The aim was to evaluate the characteristics, therapeutic needs, and scope of LVAD patients at admission to CR within a greater cohort in order to identify their special CR needs. METHODS: Retrospective single-center study; 69 LVAD patients (50.7 ± 13.6 y; 59 male; 48 HVAD; 21 HeartMate II) who completed first inpatient CR were included. Patient records were used to document relevant medical information (including the results of a 6-min walk test and a maximal isometric strength test for quadriceps femoral muscles in both legs) and the International Classification of Functioning, Disability and Health for classification of health and health-related domains. RESULTS: Patient characteristics demonstrated a heterogeneous group: CR was started 44 ± 38.6 d after implantation; CR duration was 28 ± 9.7 d. Despite similar etiology, physical and psychological condition was diverse, although, overall a high degree of impairment was present, especially in the body function (79.7%) and activity and participation (95.7%) domains. The results demonstrated the need for a highly individualized approach in the somatic and also in the education, psychosocial, and social therapeutic regimes. CONCLUSION: The results demonstrate a heterogeneous group with a high level of impairment and special needs in many CR domains. The development and evaluation of a special highly individualized approach of CR, which meets the special needs of these patients, is needed.

Exercise Capacity and Functional Performance in Heart Failure Patients Supported by a Left Ventricular Assist Device at Discharge From Inpatient Rehabilitation.

Adequate physical and functional performance is an important prerequisite for renewed participation and integration in self-determined private and (where appropriate) professional lives following left ventricular assist device (LVAD) implantation. During cardiac rehabilitation (CR), individually adapted exercise programs aim to increase exercise capacity and functional performance. A retrospective analysis of cardiopulmonary exercise capacity and functional performance in LVAD patients at discharge from a cardiac rehabilitation program was conducted. The results from 68 LVAD patients (59 males, 9 females; 55.9 ± 11.7 years; 47 HVAD, 2 MVAD, 15 HeartMate II, 4 HeartMate 3, and 4 different implanting centers) were included in the analysis. Exercise capacity was assessed using a cardiopulmonary exercise test on a bicycle ergometer (ramp protocol; 10 W/min). The 6-min walk test was used to determine functional performance. At discharge from CR (53 ± 17 days after implantation), the mean peak work load achieved was 62.2 ± 19.3 W (38% of predicted values) or 0.79 ± 0.25 W/kg body weight. The mean cardiopulmonary exercise capacity (relative peak oxygen uptake) was 10.6 ± 5.3 mL/kg/min (37% of predicted values). The 6-min walk distance improved significantly during CR (325 ± 106 to 405 ± 77 m; P < 0.01). No adverse events were documented during CR. The results show that, even following LVAD implantation, cardiopulmonary exercise capacity remains considerably restricted. In contrast, functional performance, measured by the 6-min walk distance, reaches an acceptable level. Light everyday tasks seem to be realistically surmountable for patients, making discharge from inpatient rehabilitation possible. Long-term monitoring is required in order to evaluate the situation and how it develops further.

Resistance and balance training improves functional capacity in very old participants attending cardiac rehabilitation after coronary bypass surgery.

OBJECTIVES: To compare the efficacy of intensive functional exercise training with that of usual cardiac rehabilitation (CR) in very old adults soon after coronary bypass surgery (CABG). DESIGN: Randomized controlled trial. SETTING: In-hospital CR. PARTICIPANTS: Individuals aged 75 and older (n = 173, mean 78.5 ± 3.2) participated in inpatient CR, which started soon after surgery (13.1 ± 5.3 days) and lasted for a mean of 20.4 ± 3.2 days. INTERVENTION: Participants were randomly assigned to an inpatient CR intervention group (IG; n = 84) or a control group (CG; n = 89). All participants participated in the inpatient CR program. In addition, IG participants participated in resistance training and special balance training (5 d/wk). MEASUREMENTS: Six-minute walk test, cardiopulmonary exercise testing, Timed-Up-and-Go Test (TUG), and a maximal isometric strength test were used to access functional capacity and the MacNew questionnaire to evaluate health-related quality of life (HRQL). RESULTS: There were significant improvements (P < .001) in all measured variables over the duration of CR. Improvements in functional capacity were significantly greater in the IG than the CG for 6-minute walk distance (6-MWD) (IG Δ 67.3 ± 49.0 m vs CG Δ 41.9 ± 51.7 m; P = .003), TUG time (IG Δ -2.4 ± 2.2 seconds vs CG Δ -1.2 ± 3.4 seconds; P = .005), and relative workload (IG Δ 0.19 ± 0.21 W/kg vs CG Δ 0.13 ± 0.11 W/kg; P = .03). CONCLUSION: There were significant improvements in all measured variables in very old adults participating in CR soon after CABG. With additional functional exercise training, participants randomized to IG improved significantly more than those randomized to CG on 6-MWD, TUG time, and relative workload.