Nurse Practitioner St. Mary's General Hospital Waterloo, Ontario, Canada
Disclosure(s):
Sarah Beingessner, M.N. NP: No relevant disclosure to display
Background: More than 100,000 Canadians are diagnosed with heart failure each year. Evidenced-based heart failure management includes both foundational medical therapy, and complementary non-pharmacological interventions, including self-management education, and exercise therapy. The CCS heart failure guidelines strongly recommend exercise therapy and cardiac rehabilitation programs for all stable heart failure patients. Effective self-management education for patients with heart failure has been shown to enhance long term adherence to medical therapy, reduce heart failure symptoms, and improve quality of life and functional capacity. Tailored cardiac rehabilitation programs for heart failure patients have been understudied in the literature. St. Mary’s General Hospital in Kitchener developed a cohort study that included a specialized stream for heart failure patients with reduced exercise tolerance, as evidenced by low MET level < 4.0, on intake stress testing. Targeted exercise programming was developed, along with self-management education developed by the Ottawa Heart Institute. Exercise testing measures including a 6MWT, and data was tracked on exacerbation of heart failure with visits to the emergency department/re-admission rates, at the 0 and 3-month discharge intervals. Extended follow-up was recommended with repeat testing and data tracking measures, at 6 months and 1-year post discharge.
METHODS AND RESULTS: Eighty-two patients with heart failure were enrolled in our heart failure stream from August 2022 to May 2024. The average patient age was 72 years old, with 55% male, 45% female, and over 80% of patients with a diagnosis of heart failure with reduced ejection fraction. Sixteen patients did not complete their program for multiple reasons including non-cardiac related illness or death. Thirty-two patients elected to return for repeat exercise testing measures and clinical assessment at six months post discharge, and thus far, we have had 9 patients return for a one-year follow-up. The average improvement in 6MWT at 3 months was 40 metres, with additional improvements up to 70 metres for those patients that electively returned at 6 months, and one year. Considerable improvements were also seen in other strength and flexibility measures, with an average sit to stand improvement of 20%, and one-arm curl of 28%.
Conclusion: These findings suggest that a cardiac rehabilitation program with targeted exercise and self-management education for patients with heart failure yields improvement in exercise tolerance, and reductions in rates of heart failure exacerbations. While this is an insufficient sample size to draw any statistical conclusions, the data supports further investigation in a larger cohort study.
