Chronic heart failure (CHF) Circulatory System Heart failure
Conditions
Interventions
Patients admitted to the acute medical units of the trial hospital with an acute exacerbation of CHF and are able to give informed consent will be invited to participate in the study, on day 2 or 3 of
see section on outcomes). Those assigned to the control group will be offered rehabilitation after their 3-month assessment if desired.
2. Rehabilitation: Those assigned to the intervention group can
Sponsors
University Hospitals of Leicester NHS Trust
Eligibility
Sex/Gender
All
Inclusion criteria
Inclusion criteria: 1. Patients admitted to the acute medical units of the trial hospital with an acute exacerbation of chronic heart failure (CHF) 2. Able to give informed consent 3. Aged 40 - 90 years 4. Patients admitted with an established diagnosis of CHF (documented left ventricular systolic dysfunction [LVSD]) will be independently assessed for suitability 5. Patients will have received optimal medical management 6. Impaired exercise tolerance (New York Heart Association [NYHA] classifications II - IV)
Exclusion criteria
Exclusion criteria: 1. Patients admitted for planned surgery 2. Patients with musculoskeletal or neuromuscular condition that significantly contributes to exercise limitation 3. Psychiatric or neurological conditions that would render the patient unable to comply with the training either in hospital or at home 4. Patients who have a new diagnosis of heart failure on admission will be excluded as they are likely to need ongoing medical management (i.e. establishing the correct drug regimen) and probably won?t display the same declines in physical activity as those with established chronic heart failure. 5. Usual exclusion criteria to our current out-patient exercise programme will apply: 5.1. Unstable ischaemic heart disease 5.2. Myocardial infarction (MI) within the previous 3 weeks 5.3. Planned coronary revascularization/pacemaker implantation in the next 6 months 5.4. New onset of atrial fibrillation (AF) 5.5. Complex ventricular arrhythmia 5.6. Significant regurgitant valvular disease requiring surgery 5.7. Moderate/severe aortic stenosis 5.8. Hypertrophic obstructive cardiomyopathy 5.9. Acute pericarditis or myocarditis 5.10. Recent embolism or thromboembolism 6. Terminal disease with an estimated survival time of less than 3 months to live. Medical advice may need to be sought in these cases. 7. Those with previous attendance at rehabilitation within the preceding 12 months. This includes CHF rehabilitation and rehabilitation for post-MI/angina/re-vascularisation. 8. We know in chronic obstructive pulmonary disease (COPD) that the benefits of rehabilitation have been shown to persist for 12 months. Due to the probability of multiple factors being present (such as inability to cope at home), patients will be excluded if they have had four or more hospitalisations for an acute exacerbation of their disease in the preceding 12-month period (currently only 1.1% of patients in UHL are readmitted more than four times within 12 months). In our experience these patients frequently have significant social and psychological problems triggering hospitalisation that would not be modifiable with the proposed intervention.
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| Maximal exercise performance: Incremental shuttle walk test (ISWT) at 3 months. Also collected at hospital discharge. | — |
Secondary
| Measure | Time frame |
|---|---|
| 1. Endurance exercise performance: Endurance Shuttle Walk Test (ESWT) at hospital discharge and 3 months 2. Health status, at hospital discharge and 3 months: 2.1. Disease-specific (Minnesota Living with Heart Failure and Chronic Heart) questionnaires 2.2. Generic (SF-36 and EuroQoL-5D) questionnaires 3. Psychological status: Hospital Anxiety and Depression scale at hospital discharge and 3 months 4. Quadriceps muscle strength: static maximal voluntary contraction using a strain gauge chair at inpatient day 2/3, hospital discharge and 3 months 5. Physical Activity: energy expenditure and step count using the sensewear accelerometer at inpatient day 2/3, hospital discharge and 3 months for 24/48 hours 6. Healthcare utilisation, collected for duration of the study: 6.1. Number of GP/community heart failure nurse visits 6.2. Number of emergency hospital visits 6.3. Number of admissions 6.4. Length of stay 7. Safety and tolerability: 7.1. Adverse events/response to exercise 7.2. Adherence to rehabilitation 7.3. Number of and reasons for attrition | — |
Countries
United Kingdom
Outcome results
None listed