Impact of home-based vs. centre-based cardiac rehabilitation on heart rate recovery: insights from the EXIT - heart failure trial

• Autor(a) principal: Ferreira, Rafaela
• Data de Publicação: 2024
• Tipo de documento: Dissertação
• Idioma: eng
• Título da fonte: Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)
• Texto Completo: http://hdl.handle.net/10773/41885
• topic: Heart failure; Heart rate recovery; Cardiac rehabilitation

Background: Heart rate recovery (HRR), an indicator of autonomic function, improves with exercise-based cardiac rehabilitation (CR), particularly in younger coronary artery patients and those revascularised with percutaneous intervention. However, evidence is limited, especially for patients with heart failure, particularly those in home-based interventions. The aim of this study is to compare the impact of a home-based versus centre-based CR interventions on heart rate recovery in patients with heart failure. Methods: This is a secondary analysis of the Centre- vs. Home-based CR Program in Heart Failure: a Pragmatic Randomized Clinical Trial (EXIT-HF). Patients with HF (N=120) were randomized (2:1) into two groups: home-based CR and centre-based (standard CR). Both groups participated in a 12-week combined exercise program with 2 training sessions per week, totalling 24 sessions. The centre-based group received a CR program at the hospital, including 24 supervised exercise sessions and counselling for lifestyle modification. The home-based group participated in a technology-enabled program (computer or mobile phone application linked to a wearable smartwatch) following the same exercise prescription as the centre-based group. This involved unsupervised exercise sessions and weekly phone calls providing training-specific advice for adapting the exercise program to the patient’s home environment, adjusting exercise intensity, achieving the recommended prescription, and offering counselling for lifestyle modification. HRR, determined as the difference between maximum heart rate at peak exercise and heart rate at one minute after cessation of cardiopulmonary exercise test (CPET), resting HR, resting blood pressure, peak oxygen consumption, and other clinical variables were collected at baseline and after the intervention. Results: Out of the 120 participants randomized, 34 from the clinic-based group and 61 from home-based group received the intervention and had a valid CPET. Therefore, 95 participants were included in the analyses. The mean age was 62.6±11.0 years, patients were predominantly male (64.2%), with HF with reduced ejection fraction (87.4%) and non-ischemic aetiology (65%). The change in HRR between groups was -0.6 bpm (95% CI, -4.9 to 3.7; P=0.656), with a mean (SD) change of 2.3 (9.3) bpm in the centre-based group vs 1.7 (10.4) bpm in the home-based group. Neither the centre- (from 12.4 (7.8) to 14.7 (10.2) bpm, P=0.144) nor the home-based (from 15.1 (10.7) to 16.8 (9.7) bpm, P=0.243) group significantly improved HRR after the 12-week intervention. The home-based group improved VO2 peak by 1.4±2.3 mL/Kg/min. Systolic blood pressure decreased in both groups, while diastolic blood pressure decreased only in the centre group. Conclusion: This exercise-based CR program, regardless of the setting (Home- or Centre-based), does not significantly change HRR, an indicator of autonomic function, in patients with HF.