Early hybrid cardiac rehabilitation in congenital heart disease: the QUALIREHAB trial.

Journal: European heart journal

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Affiliated Institutions:  Department of Fetal, Pediatric and Adult Congenital Cardiology, MC National CHD Reference Centre, Bordeaux University Hospital, Haut-Leveque Hospital, Avenue de Magellan, Pessac Cedex, France. Pediatric and Congenital Cardiology Department, MC Regional Reference CHD Centre, Montpellier University Hospital, Montpellier, France. Epidemiology and Clinical Research Department, University Hospital, University of Montpellier, Montpellier, France. PhyMedExp, INSERM, CNRS, University of Montpellier, Montpellier, France. Pediatric and Congenital Cardiology Department, MC National Reference CHD Centre, Marie-Lannelongue Hospital, Le Plessis-Robinson, France. Pediatric and Congenital Cardiology Department, MC Regional Reference CHD Centre, Clermont-Ferrand University Hospital, Clermont-Ferrand, France. Pediatric and Congenital Cardiology Department, MC Regional Reference CHD Centre, Toulouse University Hospital, Toulouse, France. Pediatric and Congenital Cardiology Department, MC Regional Reference CHD Centre, Grenoble University Hospital, Grenoble, France. Pediatric and Congenital Cardiology Department, MC Regional Reference CHD Centre, APHM La Timone Hospital, Marseille, France. Pediatric and Congenital Cardiology Department, Pasteur Clinic, Toulouse, France. Pediatric and Congenital Cardiology Department, MC National Reference CHD Centre, APHP Necker Hospital, Paris, France. Pediatric and Congenital Cardiology Department, Brest University Hospital, Brest, France. Fetal, Pediatric and Congenital Private Practice, rue du Conseil de l'Europe, Massy, France.

Abstract summary 

Cardiopulmonary fitness in congenital heart disease (CHD) decreases faster than in the general population resulting in impaired health-related quality of life (HRQoL). As the standard of care seems insufficient to encourage and maintain fitness, an early hybrid cardiac rehabilitation programme could improve HRQoL in CHD.The QUALIREHAB multicentre, randomized, controlled trial evaluated and implemented a 12-week centre- and home-based hybrid cardiac rehabilitation programme, including multidisciplinary care and physical activity sessions. Adolescent and young adult CHD patients with impaired cardiopulmonary fitness were randomly assigned to either the intervention (i.e. cardiac rehabilitation) or the standard of care. The primary outcome was the change in HRQoL from baseline to 12-month follow-up in an intention-to-treat analysis. The secondary outcomes were the change in cardiovascular parameters, cardiopulmonary fitness, and mental health.The expected number of 142 patients was enroled in the study (mean age 17.4 ± 3.4 years, 52% female). Patients assigned to the intervention had a significant positive change in HRQoL total score [mean difference 3.8; 95% confidence interval (CI) 0.2; 7.3; P = .038; effect size 0.34], body mass index [mean difference -0.7 kg/m2 (95% CI -1.3; -0.1); P = .022; effect size 0.41], level of physical activity [mean difference 2.5 (95% CI 0.1; 5); P = .044; effect size 0.39], and disease knowledge [mean difference 2.7 (95% CI 0.8; 4.6); P = .007; effect size 0.51]. The per-protocol analysis confirmed these results with a higher magnitude of differences. Acceptability, safety, and short-time effect of the intervention were good to excellent.This early hybrid cardiac rehabilitation programme improved HRQoL, body mass index, physical activity, and disease knowledge, in youth with CHD, opening up the possibility for the QUALIREHAB programme to be rolled out to the adult population of CHD and non-congenital cardiac disease.

Authors & Co-authors:  Amedro Gavotto Huguet Souilla Huby Matecki Cadene De La Villeon Vincenti Werner Bredy Lavastre Abassi Cohen Hascoet Dauphin Chalard Dulac Souletie Bouvaist Douchin Lachaud Ovaert Soulatges Combes Thambo Iriart Bajolle Bonnet Ansquer Delpey Cohen Picot Guillaumont

Study Outcome 

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Statistics
Citations : 
Authors :  35
Identifiers
Doi : ehae085
SSN : 1522-9645
Study Population
Male,Female
Mesh Terms
Other Terms
Congenital heart defect;Exercise therapies;Patient education;Physical activity;Physical fitness;Quality of life
Study Design
Study Approach
Country of Study
Publication Country
England