Background:
Cardiac rehabilitation (CR) is an evidence based, cost effective treatment for heart failure (HF). Globally, access to CR is limited, especially in low- and middle-income countries. An integrated model of institutional and home-based CR has been proposed as a solution to access barriers. However, the efficacy of integrated CR in this region is unknown. We performed a randomized controlled trial of integrated CR compared to usual care (no CR) among patients with stable HF in western Kenya.
Methods:
Patients with class II or III NYHA symptoms were enrolled from the Moi Teaching and Referral Hospital. Participants with arrhythmias, congenital heart disease, or stenotic valvular heart disease were excluded. Integrated CR comprised of counseling and supervised aerobic exercises 3 times a week for 1 month, followed by 2 months of monitored home-based exercises prescribed weekly via phone. Participants in both arms received health lifestyle education and wore triaxial hip pedometers. The primary outcome, change in 6-minute walk time distance (6MWTD), as well as weekly step counts were compared using the Student’s t-test.
Results:
Eighty-two participants were randomized (Figure). 6MWTD improved significantly more among the 41 patients receiving CR (45 ± 67m from baseline), compared to the usual care arm (18 ± 49m in, p<0.05), (Table). There was no significant difference in change by age, gender, BMI, ejection fraction or reported HF cause.
Conclusions:
Integrated CR improves 6MWTD among patients with HF. The findings are limited to a single center. Future studies on long-term outcomes and mechanistic processes responsible for improvement are needed.
A randomized controlled trial to assess effectiveness of a nurse-led home-based heart failure management program
