Sol ventrikül destek cihazı takılmış kalp yetmezlikli hastalarda kardiyak rehabilitasyonun fonksiyonel kapasite, psikolojik semptomlar ve yaşam kalitesi üzerine etkisi
Öz
Amaç: Bu randomize, prospektif, tek-kör çalışmanın amacı, sol ventrikül destek cihazı (SVDC) takılmış olan kalp yetmezliği hastalarında, kardiyak rehabilitasyonun yaşam kalitesi, depresyon ve fonksiyonel kapasite üzerine olan etkisinin araştırılmasıdır. Aynı zamanda, ev egzersiz programının etkinliğinin hastanede gözetimli egzersiz ile kıyaslanması amaçlanmıştır.
Gereç ve yöntem: Ege Üniversitesinde SVDC implantasyonu yapılmış olan 42 hasta çalışmaya dahil edildi. Hastalar ev egzersiz grubu (n=22) ve hastane grubu (n=20) olmak üzere iki gruba ayrıldıktan sonra, 8 hafta süren, haftada üç gün, günde bir saat olmak üzere kardiyak rehabilitasyon programına alındı. Hastalar başlangıçta ve 8. haftada değerlendirildi.
Bulgular: Çalışmamızda hastane grubunda zaman ile pik oksijen tüketimi (pik VO2), altı dakika yürüme testi, Minnesota kalp yetmezliği ile yaşam anketi skoru, State-Trait anksiyete ölçeği trait alt skorunda anlamlı iyileşme saptanmıştır (p<0,05). Ev egzersiz grubunda ise sadece kısa form-36 anketinin ağrı alt skorunda anlamlı iyileşme elde edilmiştir (p<0,05).
İncelenen parametrelerin zaman içindeki değişimleri incelendiğinde, pik VO2, altı dakika yürüme testi, Minnesota kalp yetmezliği ile yaşam anketi, State-Trait anksiyete ölçeğinin “State” anksiyete alt skorundaki iyileşmeler, hastane grubunda ev egzersiz grubuna göre anlamlı yüksek saptanmıştır (p<0,05).
Yaş ile altı dakika yürüme testindeki değişim arasında (r: -0,39, p<0,01) ayrıca yaş ile FEV1’deki değişim arasında (r: -0,35, p< 0,05) anlamlı negatif korelasyon elde edilmiştir. Kalp yetmezliği süresi ile de altı dakika yürüme mesafesindeki değişim (r: -0,25, p<0,01) ve FEV1 değerindeki değişim (r: -0,19, p< 0,05) arasında anlamlı negatif korelasyon saptanmıştır.
Pik VO2 değişimi ve altı dakika yürüme testindeki değişim (r: 0,54,p>0,01) ile FEV1 değerlerindeki değişim (r: 0,14, p>0,05) arasında pozitif korelasyon saptanmıştır.
Sonuç: Çalışmamızda hastane ortamında gözetimli kardiyak rehabilitasyon programının SVDC takılmış hastalarda pik VO2, altı dakika yürüme mesafesi, Minnesota kalp yetmezliği ile yaşam anketi, State-Trait anksiyete ölçeğinde olumlu değişime yol açtığı görülmüştür.
Anahtar Kelimeler
Destekleyen Kurum
Çalışmamız EÜTF bünyesinde yürütülmüştür, ek mali destek alınmamıştır.
Kaynakça
- Cleland JGF, Gemmell I, Khand A, Boddy A. Is the prognosis of heart failure improving? Eur. J. Heart Fail. 1999; 1:229-41.
- Ketchum ES, Levy WC. Establishing Prognosis in Heart Failure: A Multimarker Approach. Prog Cardiovasc Dis. 2011 Sep 1;54(2):86–96.
- Adebayo SO, Olunuga TO, Durodola A, Ogah OS. Quality of life in heart failure: A review. Niger J Cardiol. 2017 Jun;14(1):1-7.
- Mpe MT, Klug EQ, Silwa KS, Hitzeroth J, Smith DA. Heart Failure Society of South Africa (HeFSSA) perspective on the European Society of Cardiology (ESC) 2012 chronic heart failure guideline. S. Afr. Med. J. 2013;103:660-7.
- Adams EE, Wrightson ML. Quality of life with an LVAD: A misunderstood concept. Heart Lung. 2018 May 1;47(3):177–83
- Taylor RS, Dalal HM, McDonagh STJ. The role of cardiac rehabilitation in improving cardiovascular outcomes. Nat Rev Cardiol. 2022 Mar;19(3):180–94.
- Alsara O, Reeves RK, Pyfferoen MD, et al. Inpatient Rehabilitation Outcomes for Patients Receiving Left Ventricular Assist Device. Am. J. Phys. Med. 2014;93:860-8.
- Nguyen E, Stein J. Functional Outcomes of Adults with Left Ventricular Assist Devices Receiving Inpatient Rehabilitation. PM&R. 2013;5:99-103.
- Karapolat H, Engin C, Eroglu M, et al. Efficacy of the Cardiac Rehabilitation Program in Patients with End Stage Heart Failure, Heart Transplant Patients, and Left Ventricular Assist Device Recipients. Transplant. Proc. 2013;45:3381-5.
- Rector T. Patients' self-assessment of their congestive heart failure: Content, reliability, and validity of a new measure, the Minnesota Living with Heart Failure questionnaire. Heart failure. 1987;3:198-209.
- Uzunhasanoglu N. TF. Minnesota Kalp Yetmezliği ile Yasam Anketi (MKYYA) Türkçe Geçerlilik ve Guvenilirligi. 16 Ulusal Halk Sağlığı Kongresi. Antalya, Turkiye. 2013.
- Rector TS, Cohn JN. Assessment of patient outcome with the Minnesota Living with Heart Failure questionnaire: Reliability and validity during a randomized, double-blind, placebo-controlled trial of pimobendan. Am. Heart J. 1992;124:1017-25.
- Beck AT. An Inventory for Measuring Depression. Arch. Gen. Psychiatry. 1961;4:561.
- Şahin N. Beck depresyon envanterinin üniversite öğrencileri için geçerliği güvenirliği. Türk Psikoloji Dergisi. 1989;23:3-13.
- Ware JE, Sherbourne CD. The MOS 36-ltem Short-Form Health Survey (SF-36). Medical Care. 1992;30:473 83.
- Kocyigit H, Aydemir O, Olmez N, Memis A. Reliability and validity of the Turkish version of Short-Form-36 (SF-36). Turkish J Drugs Therap. 1999;12:102-6.
- Spielberger CD, Edwards CD, Montouri J, Lushene R. State-Trait Anxiety Inventory for Children. PsycTESTS Dataset: American Psychological Association (APA); 1973.
- Oner N. Le Comte A. Durumluk-Sürekli Kaygı Envanteri El kitabi. Oner N. Le Comte A. (Ed) 2nd ed. Bogazici Universitesi Yayinlari. Istanbul, Turkey. 1985. 20-6
- Ferguson B. ACSM’s Guidelines for Exercise Testing and Prescription 9th Ed. 2014. J Can Chiropr Assoc. Sep;58(3):328
- El Demerdash S, Khorshid H, Salah I, Abdel-Rahman MA, Salem AM. Cardiac rehabilitation improves the ischemic burden in patients with ischemic heart disease who are not suitable for revascularization. Cardiovasc Revasc Med. 2015;16:280-3.
- Marko C, Danzinger G, Käferbäck M, et al. Safety and efficacy of cardiac rehabilitation for patients with continuous flow left ventricular assist devices. Eur J Prev Cardiol. 2014;22:1378-84.
- Chu SK, McCormick Z, Hwang S, Sliwa JA, Rydberg L. Outcomes of Acute Inpatient Rehabilitation of Patients With Left Ventricular Assist Devices. PM&R. 2014;6:1008-12.
- Hayes K, Leet AS, Bradley SJ, Holland AE. Effects of exercise training on exercise capacity and quality of life in patients with a left ventricular assist device: A preliminary randomized controlled trial. J. Heart Lung Transplant. 2012;31:729-34.
- Kerrigan DJ, Williams CT, Ehrman JK, et al. Cardiac Rehabilitation Improves Functional Capacity and Patient Reported Health Status in Patients With Continuous-Flow Left Ventricular Assist Devices. JACC: Heart Fail. 2014;2:653-9.
- Jakovljevic DG, McDiarmid A, Hallsworth K, et al. Effect of Left Ventricular Assist Device Implantation and Heart Transplantation on Habitual Physical Activity and Quality of Life. Am. J. Cardiol. 2014;114:88-93.
- 26. Anderson L, Sharp GA, Norton RJ, Dalal H, Dean SG, Jolly K, Cowie A, Zawada A, Taylor RS. Home-based versus centre-based cardiac rehabilitation. Cochrane Database Syst Rev. 2017 Jun 30;6(6):CD007130
- Cowie A, Thow MK, Granat MH, Mitchell SL. Effects of home versus hospital-based exercise training in chronic heart failure. Int. J. Cardiol. 2012;158:296-8.
- Beinart NA, Goodchild CE, Weinman JA, Ayis S, Godfrey EL. Individual and intervention-related factors associated with adherence to home exercise in chronic low back pain: a systematic review. J. Spine. 2013;13:1940-50.
- Arena R, Cahalin LP, Borghi-Silva A, Myers J. The effect of exercise training on the pulmonary arterial system in patients with pulmonary hypertension. Prog Cardiovasc Dis. 2015;57:480-8.
- Kato NP, Okada I, Imamura T, et al. Quality of Life and Influential Factors in Patients Implanted With a Left Ventricular Assist Device. Circ. J. 2015;79:2186-92.
- Opasich C, Cobelli F, Assandri J, et al. Is old age a contraindication to cardiac rehabilitation after acute myocardial infarction? Eur. Heart J. 1984;5:105-7.
- Kanamori S, Takamiya T, Inoue S, Kai Y, Kawachi I, Kondo K. Exercising alone versus with others and associations with subjective health status in older Japanese: The JAGES Cohort Study. Sci Rep. 2016 Dec 15;6: 39151
- Komatsu H, Yagasaki K, Saito Y, Oguma Y. Regular group exercise contributes to balanced health in older adults in Japan: a qualitative study. BMC Geriatr. 2017 Aug 22;17(1):190.
Effects of cardiac rehabilitation on functional capacity, psychological symptoms and quality of life in patients with left ventricular assist device
Öz
Background: In this prospective randomized trial, we aimed to study the effects of cardiac rehabilitation on functional capacity, depression and quality of life, in patiens undergone left ventricular assist device (LVAD) implantation for the treatment of heart failure. We also aimed to compare the effectiveness of home and hospital based exercise programs.
Methods: 42 patients who had received LVAD implants in our university hospital were included in the study. After the subjects were randomized into hospital exercise group (n=20) and home exercise group (n=22). They were enrolled in a cardiac rehabilitation program for 8 weeks, which lasted for one hour, three times per week in hospital and at home respectively. All subjects were assessed at baseline and after the 8th week.
Results: In our study we detected a significant improvement in peak oxygen expenditure (peak VO2), six minute walk test values and in Minnesota living with heart failure quentionnaire, state- trait anxiety inventory, state anxiety subscore in the hospital exercise group (p<0.05). Home exercise group did not improve significantly in any of the parameters except in the pain subscore of Short Form-36 (p<0.05).
Comparison of the changes seen in the parameters over time, hospital group showed significantly more improvement than the home exercise group in peak VO2, six-minute walk test, Minnesota living with heart failure questionnaire and trait anxiety subscore of the state trait anxiety inventory (p<0.05).
Age (r=-0.39, p<0.01) and the duration of heart failure (r=-0.35, p<0.05) both showed a negative correlation with changes in six minute walk test and FEV1. Duration of heart failure showed a negative correlation with both the increase in 6-minute walk test (r=-0.25, p<0.01) and the increase in FEV1 values (r=-0.19, p< 0.05).
Conclusion: In this study we detected a positive effect of supervised hospital exercise program on functional capacity, quality of life and anxiety in patients with implanted LVADs.
Anahtar Kelimeler
Kaynakça
- Cleland JGF, Gemmell I, Khand A, Boddy A. Is the prognosis of heart failure improving? Eur. J. Heart Fail. 1999; 1:229-41.
- Ketchum ES, Levy WC. Establishing Prognosis in Heart Failure: A Multimarker Approach. Prog Cardiovasc Dis. 2011 Sep 1;54(2):86–96.
- Adebayo SO, Olunuga TO, Durodola A, Ogah OS. Quality of life in heart failure: A review. Niger J Cardiol. 2017 Jun;14(1):1-7.
- Mpe MT, Klug EQ, Silwa KS, Hitzeroth J, Smith DA. Heart Failure Society of South Africa (HeFSSA) perspective on the European Society of Cardiology (ESC) 2012 chronic heart failure guideline. S. Afr. Med. J. 2013;103:660-7.
- Adams EE, Wrightson ML. Quality of life with an LVAD: A misunderstood concept. Heart Lung. 2018 May 1;47(3):177–83
- Taylor RS, Dalal HM, McDonagh STJ. The role of cardiac rehabilitation in improving cardiovascular outcomes. Nat Rev Cardiol. 2022 Mar;19(3):180–94.
- Alsara O, Reeves RK, Pyfferoen MD, et al. Inpatient Rehabilitation Outcomes for Patients Receiving Left Ventricular Assist Device. Am. J. Phys. Med. 2014;93:860-8.
- Nguyen E, Stein J. Functional Outcomes of Adults with Left Ventricular Assist Devices Receiving Inpatient Rehabilitation. PM&R. 2013;5:99-103.
- Karapolat H, Engin C, Eroglu M, et al. Efficacy of the Cardiac Rehabilitation Program in Patients with End Stage Heart Failure, Heart Transplant Patients, and Left Ventricular Assist Device Recipients. Transplant. Proc. 2013;45:3381-5.
- Rector T. Patients' self-assessment of their congestive heart failure: Content, reliability, and validity of a new measure, the Minnesota Living with Heart Failure questionnaire. Heart failure. 1987;3:198-209.
- Uzunhasanoglu N. TF. Minnesota Kalp Yetmezliği ile Yasam Anketi (MKYYA) Türkçe Geçerlilik ve Guvenilirligi. 16 Ulusal Halk Sağlığı Kongresi. Antalya, Turkiye. 2013.
- Rector TS, Cohn JN. Assessment of patient outcome with the Minnesota Living with Heart Failure questionnaire: Reliability and validity during a randomized, double-blind, placebo-controlled trial of pimobendan. Am. Heart J. 1992;124:1017-25.
- Beck AT. An Inventory for Measuring Depression. Arch. Gen. Psychiatry. 1961;4:561.
- Şahin N. Beck depresyon envanterinin üniversite öğrencileri için geçerliği güvenirliği. Türk Psikoloji Dergisi. 1989;23:3-13.
- Ware JE, Sherbourne CD. The MOS 36-ltem Short-Form Health Survey (SF-36). Medical Care. 1992;30:473 83.
- Kocyigit H, Aydemir O, Olmez N, Memis A. Reliability and validity of the Turkish version of Short-Form-36 (SF-36). Turkish J Drugs Therap. 1999;12:102-6.
- Spielberger CD, Edwards CD, Montouri J, Lushene R. State-Trait Anxiety Inventory for Children. PsycTESTS Dataset: American Psychological Association (APA); 1973.
- Oner N. Le Comte A. Durumluk-Sürekli Kaygı Envanteri El kitabi. Oner N. Le Comte A. (Ed) 2nd ed. Bogazici Universitesi Yayinlari. Istanbul, Turkey. 1985. 20-6
- Ferguson B. ACSM’s Guidelines for Exercise Testing and Prescription 9th Ed. 2014. J Can Chiropr Assoc. Sep;58(3):328
- El Demerdash S, Khorshid H, Salah I, Abdel-Rahman MA, Salem AM. Cardiac rehabilitation improves the ischemic burden in patients with ischemic heart disease who are not suitable for revascularization. Cardiovasc Revasc Med. 2015;16:280-3.
- Marko C, Danzinger G, Käferbäck M, et al. Safety and efficacy of cardiac rehabilitation for patients with continuous flow left ventricular assist devices. Eur J Prev Cardiol. 2014;22:1378-84.
- Chu SK, McCormick Z, Hwang S, Sliwa JA, Rydberg L. Outcomes of Acute Inpatient Rehabilitation of Patients With Left Ventricular Assist Devices. PM&R. 2014;6:1008-12.
- Hayes K, Leet AS, Bradley SJ, Holland AE. Effects of exercise training on exercise capacity and quality of life in patients with a left ventricular assist device: A preliminary randomized controlled trial. J. Heart Lung Transplant. 2012;31:729-34.
- Kerrigan DJ, Williams CT, Ehrman JK, et al. Cardiac Rehabilitation Improves Functional Capacity and Patient Reported Health Status in Patients With Continuous-Flow Left Ventricular Assist Devices. JACC: Heart Fail. 2014;2:653-9.
- Jakovljevic DG, McDiarmid A, Hallsworth K, et al. Effect of Left Ventricular Assist Device Implantation and Heart Transplantation on Habitual Physical Activity and Quality of Life. Am. J. Cardiol. 2014;114:88-93.
- 26. Anderson L, Sharp GA, Norton RJ, Dalal H, Dean SG, Jolly K, Cowie A, Zawada A, Taylor RS. Home-based versus centre-based cardiac rehabilitation. Cochrane Database Syst Rev. 2017 Jun 30;6(6):CD007130
- Cowie A, Thow MK, Granat MH, Mitchell SL. Effects of home versus hospital-based exercise training in chronic heart failure. Int. J. Cardiol. 2012;158:296-8.
- Beinart NA, Goodchild CE, Weinman JA, Ayis S, Godfrey EL. Individual and intervention-related factors associated with adherence to home exercise in chronic low back pain: a systematic review. J. Spine. 2013;13:1940-50.
- Arena R, Cahalin LP, Borghi-Silva A, Myers J. The effect of exercise training on the pulmonary arterial system in patients with pulmonary hypertension. Prog Cardiovasc Dis. 2015;57:480-8.
- Kato NP, Okada I, Imamura T, et al. Quality of Life and Influential Factors in Patients Implanted With a Left Ventricular Assist Device. Circ. J. 2015;79:2186-92.
- Opasich C, Cobelli F, Assandri J, et al. Is old age a contraindication to cardiac rehabilitation after acute myocardial infarction? Eur. Heart J. 1984;5:105-7.
- Kanamori S, Takamiya T, Inoue S, Kai Y, Kawachi I, Kondo K. Exercising alone versus with others and associations with subjective health status in older Japanese: The JAGES Cohort Study. Sci Rep. 2016 Dec 15;6: 39151
- Komatsu H, Yagasaki K, Saito Y, Oguma Y. Regular group exercise contributes to balanced health in older adults in Japan: a qualitative study. BMC Geriatr. 2017 Aug 22;17(1):190.
Ayrıntılar
| Birincil Dil | İngilizce |
|---|---|
| Konular | Klinik Tıp Bilimleri (Diğer) |
| Bölüm | Araştırma Makaleleri |
| Yazarlar | |
| Yayımlanma Tarihi | 10 Haziran 2024 |
| Gönderilme Tarihi | 3 Ağustos 2023 |
| Yayımlandığı Sayı | Yıl 2024 |