Influence of medical rehabilitation at the annual prognosis for chronic heart failure patients

Cardiac rehabilitation is an important part of medical care for patients with cardiovascular diseases.

The aim: to estimate the prognosis of patients with chronic heart failure (CHF) with preserved ejection fraction during 12 months of observation in the conditions of medical rehabilitation.

Material and methods. The study was performed from 01.11.2022 to 01.12.2024 at Novosibirsk Regional Clinical Hospital for War Veterans No. 3. It included 260 patients (mean age 65.4 ± 8.6 years) with post-infarction cardiosclerosis and CHF. Patients were divided into 2 groups: the main group – patients who underwent medical rehabilitation (course duration 14.4 ± 2.3 days) after myocardial infarction in the inpatient medical rehabilitation department (n = 132); the comparison group – patients who refused to undergo cardiac rehabilitation (n = 128). The average interval from acute myocardial infarction to inclusion of patients in the study was 1.5 ± 0.4 months. At the first and second (after 12 months) stages, an assessment of clinical status, life quality (EQ-5D questionnaire), objective examination data, 6-minute walk test results, laboratory parameters (including NT-proBNP level), instrumental studies with an assessment of “hard” (cardiovascular death, hospitalization for acute decompensation of heart failure, acute myocardial infarction, myocardial revascularization, new cases of rhythm disturbance, acute cerebrovascular accident) and “soft” (left ventricular ejection fraction, functional class of CHF, quality of life) endpoints was made.

Results. Cardiac rehabilitation demonstrated a significant effect on reducing the risk of mortality (odds ratio 8.628; 95% confidence interval: 1.931–38.545, p < 0.001), improving myocardial contractility (left ventricular ejection fraction increased from 56.0 ± 3.0 to 65.3 ± 3.6%, p = 0.048), changing the distribution of functional classes of CHF (the proportion of patients with functional class II increased from 49.2 to 62.3%, p = 0.03; the proportion of patients with functional class III decreased from 42.5 to 26.2%, p = 0.01), improving quality of life (results on the EQ-5D questionnaire increased from 60.3 ± 7.3 to 82.5 ± 6.6 points; p = 0.02). In addition, in the comparison group, the probability of the combined endpoint was 8.6 times higher (odds ratio 8.667; 95% confidence interval: 4.888– 15.366, p < 0.001).

Conclusion. The results of the study indicate the importance of integrating cardiac rehabilitation into a long-term strategy for managing patients with CHF in order to improve the prognosis.