Is ventilatory therapy combined with exercise training effective in patients with heart failure and sleep-disordered breathing? Results of a randomized trial during a cardiac rehabilitation programme (SATELIT-HF)

Introduction 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.

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Rationale And Design Of The SERVE HF Study: Treatment Of Sleep-disordered Breathing With Predominant Central Sleep Apnea By Adaptive Servo Ventilation In Patients With Heart Failure

10.1164/ajrccm-conference.2010.181.1_meetingabstracts.a5580 ◽

2010 ◽

Author(s):

Helmut Teschler ◽

Martin R. Cowie ◽

Marie-Pia d`Ortho ◽

Christiane Angermann ◽

Erland Erdmann ◽

...

Keyword(s):

Heart Failure ◽

Sleep Apnea ◽

Sleep Disordered Breathing ◽

Central Sleep Apnea ◽

Adaptive Servo Ventilation ◽

Patients With Heart Failure ◽

Disordered Breathing

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Identifying elements for a comprehensive paediatric cardiac rehabilitation programme

Cardiology in the Young ◽

10.1017/s1047951120002346 ◽

2020 ◽

Vol 30 (10) ◽

pp. 1473-1481

Author(s):

Tracy Curran ◽

Naomi Gauthier ◽

Susan M. Duty ◽

Rachele Pojednic

Keyword(s):

Congenital Heart Disease ◽

Heart Disease ◽

Exercise Training ◽

Cardiac Rehabilitation ◽

Congenital Heart ◽

Rehabilitation Programme ◽

Delphi Panel ◽

Healthcare Team ◽

Cardiac Rehabilitation Programme ◽

Self Confidence

AbstractIntroduction:The aim of this study was to identify relevant content among four important domains for the development and structure of a paediatric cardiac rehabilitation curriculum for young patients with congenital heart disease using a consensus approach.Methods:A three-round e-Delphi study among congenital heart disease and paediatric exercise physiology experts was conducted. Round 1, experts provided opinions in a closed- and open-ended electronic questionnaire to identify specific elements necessary for inclusion in a paediatric cardiac rehabilitation programme. Round 2, experts were asked to re-rate the same items after feedback and summary data were provided from round 1. Round 3, the same experts were asked to re-rate items that did not reach consensus from round 2.Results:Forty-seven experts were contacted via e-mail to participate on the Delphi panel, 37 consented, 35 completed round 1, 29 completed round 2, and 28 completed the final round. After round 2, consensus was reached in 55 of 60 (92%) questionnaire items across four domains: exercise training, education, outcome metrics, and self-confidence.Conclusion:This study established consensus towards programme structure, exercise training principles, educational content, patient outcome measures, and self-confidence promotion. By identifying the key components within each domain, there is potential to benchmark recommended standards and practice guidelines for the development of a paediatric cardiac rehabilitation curriculum to be used and tested by exercise physiologists, paediatric and adult congenital cardiologists, and other healthcare team members for optimising the health and wellness of paediatric patients with congenital heart disease.

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Current Insights into Exercise-based Cardiac Rehabilitation in Patients with Coronary Heart Disease and Chronic Heart Failure

International Journal of Sports Medicine ◽

10.1055/a-1198-5573 ◽

2020 ◽

Vol 42 (01) ◽

pp. 19-26

Author(s):

Simon Nichols ◽

Gordon McGregor ◽

Jeff Breckon ◽

Lee Ingle

Keyword(s):

Heart Failure ◽

Coronary Heart Disease ◽

Heart Disease ◽

Chronic Heart Failure ◽

Exercise Training ◽

Cardiac Rehabilitation ◽

Behaviour Change ◽

Cardiac Patients ◽

Community Based ◽

Cardiac Rehabilitation Programme

AbstractCardiac rehabilitation is a package of lifestyle secondary prevention strategies designed for patients with coronary heart disease and chronic heart failure. A community-based cardiac rehabilitation programme provides patients with a structured exercise training intervention alongside educational support and psychological counselling. This review provides an update regarding the clinical benefits of community-based cardiac rehabilitation from a psycho-physiological perspective, and also focuses on the latest epidemiological evidence regarding potential survival benefits. Behaviour change is key to long-term adoption of a healthy and active lifestyle following a cardiac event. In order for lifestyle interventions such as structured exercise interventions to be adopted by patients, practitioners need to ensure that behaviour change programmes are mapped against patient’s priorities and values, and adapted to their level of readiness and intention to engage with the target behaviour. We review the evidence regarding behaviour change strategies for cardiac patients and provide practitioners with the latest guidance. The ‘dose’ of exercise training delivered to patients attending exercise-based cardiac rehabilitation is an important consideration because an improvement in peak oxygen uptake requires an adequate physiological stimulus to invoke positive physiological adaptation. We conclude by critically reviewing the latest evidence regarding exercise dose for cardiac patients including the role of traditional and more contemporary training interventions including high intensity interval training.

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