Abstract
BackgroundAtrial fibrillation (AF) is common in individuals with heart failure (HF). Individuals with either or both HF and AF may have a reduced functional capacity and quality of life which leads to hospital admission and burden on clinical services. Evidence supports the effect of exercise training in individuals with HF. However, there is little existing data on the effectiveness of comprehensive cardiac rehabilitation (CR) programme in individuals with HF and AF.AimTo explore the effect of a comprehensive CR programme for individuals with HF and AF compared to those with no-coexisting AF.MethodsUsing Glenfield Hospital CR database, individuals with HF and co-existing AF were identified, and propensity matched 1:1 to those with HF and no co-existing AF. Matching was conducted using age, gender, Body Mass Index (BMI), Left Ventricular Ejection Fraction (LVEF) and New York Heart Association (NYHA) class. The change in incremental shuttle walking test (ISWT) distance, Heart Disease Quality of Life Questionnaire (MacNew), Hospital Anxiety and Depression (HADS) scores were compared between groups pre and post CR.ResultsData were collected from 484 individuals, (n=149) had HF and co-existing AF. 149 individuals were propensity matched from each group. The mean ± SD age of the matched sample was 73.4 ± 8 years, BMI 29.2 ± 5.5 Kg/m2, LVEF 35.2 ± 9.8 %, NYHA class (median [IQR]) (2 [2 – 3]) and 56 % were male. A statistically significant improvement in exercise capacity, heart disease quality of life, anxiety and depression scores were made within each group. However, there were no significant differences between groups for any of these outcome measures (table 1).Abstract 14 Table 1Clinical outcome measures of two matched groups at baseline and after CR Patients with HF and co-existing AFn=149 Patients with HFn=149 Between groups difference Pre Post Mean Difference (95%CI) Pre Post Mean Difference (95%CI) P-Value ISWT (m) 235 ± 137285 ± 149*50*(39.5 , 60.8)285 ± 158332 ± 168* 47*(33.7, 60.6)0.75 HADS anxiety score 5 ± 33 ± 2*-2*(-1.8, -.8)5 ± 44 ± 3*-1*(-1.3, -.4)0.21 HADS depression score 4 ± 33 ± 2*-1*(-1.8, -.8)4 ± 44 ± 3*0*(-1.3, -.4)0.40 MacNew overall score 21 ± 423 ± 3*2*(1.4, 2.8)20 ± 422 ± 4*2*(1.4, 2.8)0.18Data are presented as mean±SD or mean change (95% CI) unless otherwise stated. p Value represents comparison between group.AF: Atrial Fibrillation, ISWT: Incremental Shuttle Walking Test, HADS: Hospital Anxiety and Depression Scores, MacNew: Heart Disease HRQL questionnaire.* Within group difference p<0.05ConclusionIndividuals with HF and co-existing AF gain a similar improvement in exercise capacity and health related quality of life outcomes as individuals with HF alone following completion of a CR programme.