Authors

1. Schloglhofer, Thomas MSc
2. Gross, Christoph Dr scient med
3. Moscato, Francesco PhD
4. Neumayer, Alexander MSc
5. Kandioler, Elisabeth MD
6. Leithner, Daniela Mag
7. Skoumal, Martin MD
8. Laufer, Gunther MD
9. Wiedemann, Dominik MD
10. Schima, Heinrich PhD
11. Zimpfer, Daniel MD
12. Marko, Christiane MD

Abstract

Purpose: Exercise performance and quality of life (QoL) of left ventricular assist device (LVAD) patients improve after early cardiac rehabilitation (CR). The purpose of this study was to examine the efficacy of multiprofessional long term phase 3 outpatient CR, and whether cardiopulmonary exercise testing (CPX) and 6-min walk testing (6MWT) post-LVAD implantation predict hospital readmission.

Methods: This retrospective observational cohort study included 29 LVAD patients (58.6 +/- 7.7 yr, female: 13.8%, body mass index: 29.4 +/- 3.3 kg/m²). Functional performance tests (CPX, 6MWT, sit-to-stand test), QoL, and psychological surveys (Kansas City Cardiomyopathy Questionnaire, hospital anxiety and depression scale, and Control Convictions about Disease and Health [KKG]) were performed at baseline and at the end of CR.

Results: The CR was initiated at a median (IQR) of 159 (130-260) d after LVAD implantation for a duration of 340 (180-363) d with 46.8 +/- 23.2 trainings. The 6MWT (408.4 +/- 113.3 vs 455.4 +/- 115.5 m, P = .003) and sit-to-stand test (16.7 +/- 6.9 vs 19.0 +/- 5.3 repetitions, P = .033) improved, but relative peak oxygen uptake (V[spacing dot above]O_2peak: 9.4 [8.2-14.4] vs 9.3 [7.8-13.4] mL/min/kg, P = .57) did not change. Using receiver operating characteristic curve analysis, baseline V[spacing dot above]O_2peak values were associated with readmission 1-yr after CR onset (C-statistic = 0.88) with a cutoff value of V[spacing dot above]O_2peak < 9.15 mL/min/kg (100% sensitivity, 78% specificity, P < .001). The Kansas City Cardiomyopathy Questionnaire self-efficacy and knowledge (+6.3 points), QoL (+5.0 points), and social limitation (+7.1 points) demonstrated clinically important changes. In addition, the hospital anxiety and depression scale showed a significant reduction in anxiety (4.6 +/- 3.2 vs 2.6 +/- 2.4, P = .03).

Conclusions: Long-term CR is safe and LVAD outpatients showed improvement of QoL, anxiety, and submaximal exercise performance. In addition, V[spacing dot above]O_2peak and 6MWT have prognostic value for readmission.