Outcome of Cardiac Rehabilitation in Patients with an LVAD

Introduction: By now the yearly number of patients receiving an LVAD has exceeded the number of cardiac transplant recipients.

Primarily intended as a bridge to transplantation, LVAD implantation is becoming a destination therapy for the majority of the patients concerned. There are only few reports about the outcome of rehabilitation in patients receiving an LVAD.

Methods: The results of rehabilitation in 61 patients after receiving an LVAD were analyzed. The data were routinely collected for quality assurance.

Results: The group consisted of 51 men and 11 women with a mean age of 62 years. Maximum workload did not change within rehabilitation, yet peak oxygen uptake did increase significantly (10.0 to 11.94 ml/min/kg, p< 0.001). The distance in the 6-minute walk test increased significantly from 251 to 280 m. Barthel index showed a significant increase from 57 to 74 points. The results of the HADS changed significantly from 6,1 to 4,4 whereas the HADS A test showed no significant change, neither did the BNP (Brain natriuretic peptide) level change significantly. 11 patients had to be readmitted to hospital, the rest of the group could be discharged home.

Conclusion: The treatment of patients with an LVAD imposes new tasks on cardiac rehabilitation. Training control using the heart rate is not possible due to the technical implications.

In addition, an intensive psychosocial care is necessary to comply with the needs and desires of the patients. The results showed a marked improvement of cardiopulmonary exercise and self-help capacity.

In most cases, a home discharge was possible and patients could live a self-determined life. Medical advances and the decreasing number of donor organs will lead to a growing number of LVADs, a challenge which also has to be met by cardiac rehabilitation.