Authors (including presenting author) :
K Fan(1), KL Wong(1), CY Yung(1), KF Wong(1), KY Cheng(1), YM Chow(1), KL Au(1), YL Kong(1), MY Lee(1), TY Fu(2), TK Wong(2), CSF Yau(3), KW Chan(3), YN Ho(3), V Siu(4), A Lee(4), D Hung(5), E Wong(6)
Affiliation :
(1)Cardiac Medical Unit, Grantham Hospital, (2)Physiotherapy Department, Grantham Hospital, (3)Occupational Therapy Department, Grantham Hospital, (4)Pharmacy Department, Grantham Hospital, (5) Clinical Psychology Department, Grantham Hospital, (6)Dietetics Services, Grantham Hospital
Introduction :
Cardiac rehabilitation (CR) has been applied predominantly to patients (pts) with coronary artery disease (either acute or chronic coronary syndromes) with low to moderate risk of cardiovascular complications. Pts with advanced heart failure with reduced ejection fraction (HFrEF) were under-represented.
Objectives :
To presented our early experiences of multidisciplinary comprehensive intervention offered to the cohort of advanced HFrEF pts.
Methodology :
From September 2021 to December 2022, 64 HFrEF pts were enrolled and underwent individualized, risk-stratified, structured multidisciplinary CR (MDCR) with different modules including exercise training, self-management skills programs, medication reconciliation, dietary counselling and psychosocial support. Parameters at baseline and post CR program were compared. Emergency hospitalization during 6 months before after start of the program were compared with 6 months post MDCR.
Result & Outcome :
Sixty-four patients (mean age was 53.93 +/- 9.68 years, 85.9% men) were enrolled. 36.9% had ischemic cardiomyopathy. Mean left ventricular EF was 26.4 +/- 10.48%. There was significant improvement in exercise capacity (baseline mean 5.91 +/- 1.69 METS vs post MDCR mean 7.71 +/- 2.10 METS; p<0.001).
Statistically significant difference was found in all sub-scales in Self-Care of Heart Failure Index- Chinese version(SCHFI-CV): self-care maintenance; p=0.013, symptoms perception; p=0.014, and self-care management; p=0.001. Self-Care Self-Efficacy Scale (SCSES); p= 0.001, and Hospital Anxiety and Depression Scale (HADS)- Anxiety; p= 0.014, Depression; p= 0.006. Results showed significant improvement at the end of MDCR program.
No adverse events were reported during rehabilitation exercise program. All patients had cardiac medications reviewed and optimized. Combined HF and emergency hospitalizations were significantly reduced by almost eightfold from mean 1.60 before MDCR program to mean 0.22 after the program (p<0.001). HF hospitalization also significantly reduced by more than tenfold from mean 0.54 before MDCR program to mean 0.04 after the program (p<0.001).
Conclusions:
Early pilot program of MDCR is safe and beneficial in pts with advanced HF with significantly improved exercise capacity, overall self-management on behavioural changes, and reduction of symptoms of depression. The risks of emergency and HF hospitalizations were also significantly reduced.
These findings can guide future implementation of multidisciplinary HF care, which echoed the need for patient-centered and flexible trajectories, rather than rigid centralized approaches.
