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Benefits of cardiac rehabilitation in heart failure patients according to etiology: INCARD French study.

Koukoui F, Desmoulin F, Lairy G, Bleinc D, Boursiquot L, Galinier M, Smih F, Rouet P - Medicine (Baltimore) (2015)

Bottom Line: INCARD is a French study aimed at evaluating the benefits of sustainable CR in coronary (C) and noncoronary patients (NC) treated and educated during a 24-month period of follow-up.Only NC showed an improved LVEF during the first 3 months of outpatient-follow-up.The results on functional parameters suggest exercise training should be conducted regardless of the HF etiology.

View Article: PubMed Central - PubMed

Affiliation: From the INSERM I2MC, UMR 1048, Université UPS, Equipe «Obésité et insuffisance cardiaque: approches moléculaires et cliniques », Toulouse (FK, FD, MG, FS, PR); Service de Réadaptation Cardiaque Centre Hospitalier Sud Francilien, 116 Boulevard Jean Jaurès, Corbeil-Essonnes, (FK, GL, DB, LB); and Cardiology Department, Rangueil Hospital University, Toulouse, France (MG).

ABSTRACT
We investigated the impact of heart failure (HF) etiology on the outcome of cardiac rehabilitation (CR) assessed by functional and clinical parameters. Treatment of chronic HF requires multidisciplinary approaches with a recognized role for CR. INCARD is a French study aimed at evaluating the benefits of sustainable CR in coronary (C) and noncoronary patients (NC) treated and educated during a 24-month period of follow-up. Prospective, monocentric patients with HF underwent inpatient physical training followed by a home-based program. Evaluations were performed at inclusion, discharge, 3 months after discharge, and subsequently every 6 months over the 24 months of outpatient rehabilitation.A total of 147 HF patients with left ventricular ejection fraction (LVEF) <40 were admitted to the CR center, 63 accepted to join INCARD (29 C and 34 NC). Although the C participants C having both an echocardiographic LVEF and an initially lower peak VO2, inpatient rehabilitation improved all functional parameters. Only NC showed an improved LVEF during the first 3 months of outpatient-follow-up. The main outcome of the outpatient rehabilitation was a trend toward stabilization of clinical and laboratory parameters with no significant difference between C and NC. This study confirms the benefits of initial HF inpatient rehabilitation and encourages prolonged outpatient monitoring. The results on functional parameters suggest exercise training should be conducted regardless of the HF etiology.

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Related in: MedlinePlus

Medication management during the follow-up. Percentages of coronary (A) and noncoronary (B) patients treated with beta-blockers, angiotensin-converting enzyme inhibitors (ACEIs), loop diuretics, anti-aldosterone, or angiotensin II receptor blockers (ARBs) are indicated for each evaluation during the inpatient follow-up (I) period and outpatient follow-up (O) period. ∗% treated patients significantly different between C and NC, P < 0.05.
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Figure 2: Medication management during the follow-up. Percentages of coronary (A) and noncoronary (B) patients treated with beta-blockers, angiotensin-converting enzyme inhibitors (ACEIs), loop diuretics, anti-aldosterone, or angiotensin II receptor blockers (ARBs) are indicated for each evaluation during the inpatient follow-up (I) period and outpatient follow-up (O) period. ∗% treated patients significantly different between C and NC, P < 0.05.

Mentions: Drug treatment was conducted according to the recommendations of the European Society of Cardiology. Optimization of beta-blocker treatment occurred during the study started at 63% and reached 86% of all patients at the end of inpatient follow-up (Figure 2). There was no difference between treatment coverage of C and NC until the T3 evaluation. The coverage of anti-aldosterone drugs at T3 was 17% and 45% for C and NC, respectively (P < 0.05), and the coverage rate at T5 of the angiotensin II receptor blockers was 43% and 0% (P < 0.01), whereas that of angiotensin-converting-enzyme inhibitors was 57% and 95% (P < 0.05) for C and NC, respectively.


Benefits of cardiac rehabilitation in heart failure patients according to etiology: INCARD French study.

Koukoui F, Desmoulin F, Lairy G, Bleinc D, Boursiquot L, Galinier M, Smih F, Rouet P - Medicine (Baltimore) (2015)

Medication management during the follow-up. Percentages of coronary (A) and noncoronary (B) patients treated with beta-blockers, angiotensin-converting enzyme inhibitors (ACEIs), loop diuretics, anti-aldosterone, or angiotensin II receptor blockers (ARBs) are indicated for each evaluation during the inpatient follow-up (I) period and outpatient follow-up (O) period. ∗% treated patients significantly different between C and NC, P < 0.05.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4554184&req=5

Figure 2: Medication management during the follow-up. Percentages of coronary (A) and noncoronary (B) patients treated with beta-blockers, angiotensin-converting enzyme inhibitors (ACEIs), loop diuretics, anti-aldosterone, or angiotensin II receptor blockers (ARBs) are indicated for each evaluation during the inpatient follow-up (I) period and outpatient follow-up (O) period. ∗% treated patients significantly different between C and NC, P < 0.05.
Mentions: Drug treatment was conducted according to the recommendations of the European Society of Cardiology. Optimization of beta-blocker treatment occurred during the study started at 63% and reached 86% of all patients at the end of inpatient follow-up (Figure 2). There was no difference between treatment coverage of C and NC until the T3 evaluation. The coverage of anti-aldosterone drugs at T3 was 17% and 45% for C and NC, respectively (P < 0.05), and the coverage rate at T5 of the angiotensin II receptor blockers was 43% and 0% (P < 0.01), whereas that of angiotensin-converting-enzyme inhibitors was 57% and 95% (P < 0.05) for C and NC, respectively.

Bottom Line: INCARD is a French study aimed at evaluating the benefits of sustainable CR in coronary (C) and noncoronary patients (NC) treated and educated during a 24-month period of follow-up.Only NC showed an improved LVEF during the first 3 months of outpatient-follow-up.The results on functional parameters suggest exercise training should be conducted regardless of the HF etiology.

View Article: PubMed Central - PubMed

Affiliation: From the INSERM I2MC, UMR 1048, Université UPS, Equipe «Obésité et insuffisance cardiaque: approches moléculaires et cliniques », Toulouse (FK, FD, MG, FS, PR); Service de Réadaptation Cardiaque Centre Hospitalier Sud Francilien, 116 Boulevard Jean Jaurès, Corbeil-Essonnes, (FK, GL, DB, LB); and Cardiology Department, Rangueil Hospital University, Toulouse, France (MG).

ABSTRACT
We investigated the impact of heart failure (HF) etiology on the outcome of cardiac rehabilitation (CR) assessed by functional and clinical parameters. Treatment of chronic HF requires multidisciplinary approaches with a recognized role for CR. INCARD is a French study aimed at evaluating the benefits of sustainable CR in coronary (C) and noncoronary patients (NC) treated and educated during a 24-month period of follow-up. Prospective, monocentric patients with HF underwent inpatient physical training followed by a home-based program. Evaluations were performed at inclusion, discharge, 3 months after discharge, and subsequently every 6 months over the 24 months of outpatient rehabilitation.A total of 147 HF patients with left ventricular ejection fraction (LVEF) <40 were admitted to the CR center, 63 accepted to join INCARD (29 C and 34 NC). Although the C participants C having both an echocardiographic LVEF and an initially lower peak VO2, inpatient rehabilitation improved all functional parameters. Only NC showed an improved LVEF during the first 3 months of outpatient-follow-up. The main outcome of the outpatient rehabilitation was a trend toward stabilization of clinical and laboratory parameters with no significant difference between C and NC. This study confirms the benefits of initial HF inpatient rehabilitation and encourages prolonged outpatient monitoring. The results on functional parameters suggest exercise training should be conducted regardless of the HF etiology.

Show MeSH
Related in: MedlinePlus