Time-to-referral, use, and efficacy of cardiac rehabilitation after heart transplantation.

Abstract

BACKGROUND:

Timely access, adherence, and efficacy of cardiac rehabilitation programs (CRP) are important given the potential to mitigate or reverse the side effects of immunosuppressive medications, weight gain, and cardiovascular deconditioning that place heart transplant (HT) recipients at increased cardiovascular risk. However, there is a dearth of information on use and efficacy of CRPs. Therefore, we examined process indicators (time to referral and correlates, program adherence) and clinical outcome indicators (functional capacity (VO(2peak)), anthropometrics) of CR post-HT compared to post-coronary artery bypass graft (CABG).

METHODS:

Baseline, 6-month exercise stress test results, and anthropometrics were examined retrospectively among consecutively enrolled post-HT and age-matched and sex-matched CABG patients. Time to referral and program entry, attendance, and completion rates were also measured.

RESULTS:

Heart transplant (n=43) and CABG patients were referred 24.9 ± 48.9 and 2.1 ± 3.6 months, respectively, after surgery (P=0.003). Once referred, there was no difference in elapsed-time to program entry (P=0.2). There was a positive relationship between time to referral and baseline waist circumference (r=0.5, P=0.001), body mass index (r=0.5, P=0.002), hip circumference (r=0.4, P=0.008), and body fat percentage (r=0.4, P=0.03) in HT. Heart transplant and CABG patients had similar rates of CRP dropout (27.9% vs. 37.2% respectively, P=0.4). There was improvement in VO(2peak) for HT (2.4 ± 4.2 mL/kg/min; P=0.02) and CABG (5.5 ± 5.4 mL/kg/min, P<0.001), but was greater for CABG (P=0.04). Anthropometric measures remained stable for both cohorts (P>0.05).

CONCLUSION:

There is a lengthy delay in time from HT to CRP referral, though once referred, gain significant benefit in functional capacity. The appropriateness of this wait needs to be elucidated; however, it appears that longer wait times are associated with adverse effects on body composition.

• Authors: Susan Marzolini, Sherry L Grace, Dina Brooks, Dale Corbett, Sunita Mathur, Robert Bertelink, Valerie Skeffington, David Alter, Paul Oh
• Journal: Transplantation (Transplantation) Vol. 99 Issue 3 Pg. 594-601 (Mar 2015) ISSN: 1534-6080 [Electronic] United States
• PMID: 25119127 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Immunosuppressive Agents
• Oxygen

Topics

• Adult
• Aged
• Anthropometry
• Body Composition
• Body Mass Index
• Coronary Artery Bypass (methods)
• Exercise Test
• Female
• Heart Failure (surgery)
• Heart Transplantation
• Humans
• Immunosuppressive Agents (therapeutic use)
• Male
• Middle Aged
• Oxygen (chemistry)
• Retrospective Studies
• Risk Factors
• Time Factors
• Time-to-Treatment