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Canadian Journal of Cardiology

The Impact of Cardiac Rehabilitation on Mental and Physical Health in Patients With Atrial Fibrillation: A Matched Case-Control Study

Published:August 29, 2018DOI:https://doi.org/10.1016/j.cjca.2018.08.035

      Abstract

      Background

      Patients with atrial fibrillation (AF) experience symptom burden, exercise intolerance, weight gain, poor mental health, and diminished quality of life (QoL). Cardiac rehabilitation (CR) is recommended for patients with heart disease, and its benefits are well established, yet clinical guidelines for patients with AF do not include the referral to CR.

      Methods

      In this matched retrospective, case-control study, we examined the impact of CR on changes in QoL, mental health, and cardiometabolic health indicators in patients with or without persistent or permanent AF. Patients attended CR that addressed risk factor management and provided support services and exercise training twice weekly for 3 months. Height, body mass, waist circumference, blood pressure, and heart rate were measured, and the Short Form-36 and Hospital Anxiety and Depression Scale were administered at baseline and 3 months follow-up.

      Results

      A total of 94 patients (AF, n = 47; no AF, n = 47) (aged 70 ± 8 years) participated. Significant improvements in 2 of the 8 subscales and the Physical Component Summary of the Short Form-36 were observed across groups after CR (P < 0.05). Significant interactions revealed that the effect of CR was greater for energy, emotional well-being, social functioning, pain, and the Physical Component Summary in patients without AF (P < 0.05 for each). No significant improvements in anxiety (AF: −1.3 ± 3.4; no AF: −1.3 ± 4.3), depression (AF: −1.1 ± 2.9; no AF: −0.4 ± 2.7), body mass index (AF: −0.5 ± 1.2; no AF: −0.8 ± 1.5, kg/m2), waist circumference (AF: −1.7 ± 4.6; no AF: 0.4 ± 8.1, cm), or blood pressure (AF: −2.3 ± 17.1/−3.9 ± /9.3; no AF: 1.8 ± 16.4/−0.8 ± /9.3 mm Hg) were observed across groups after CR.

      Conclusions

      CR improved QoL to a greater extent in patients with heart disease without than with persistent or permanent AF.

      Résumé

      Contexte

      Les patients atteints de fibrillation auriculaire (FA) doivent composer avec de lourds symptômes, une intolérance à l’activité physique, un gain de poids, des problèmes de santé mentale et une diminution de leur qualité de vie (QdV). Alors que la réadaptation cardiaque (RC) est recommandée aux patients atteints d’une cardiopathie et que ses bienfaits sont bien établis, les lignes directrices cliniques applicables aux patients atteints de FA ne mentionnent pas l’orientation vers la RC.

      Méthodologie

      Dans cette étude rétrospective cas-témoins appariés, nous avons analysé l’effet de la RC sur la QdV, la santé mentale et les indicateurs de la santé cardiométabolique chez des patients avec ou sans FA persistante ou permanente. Les patients avaient suivi un programme de RC comprenant de la formation sur la gestion des facteurs de risque, des services de soutien et des séances d’activité physique deux fois par semaine pendant trois mois. La taille, la masse corporelle, le tour de taille, la pression artérielle et la fréquence cardiaque avaient été mesurés, et les questionnaires Short Form-36 (questionnaire abrégé sur la santé) et Hospital Anxiety and Depression Scale (échelle hospitalière de mesure de l’anxiété et de la dépression) avaient été administrés au début de l’étude et lors du suivi à 3 mois.

      Résultats

      Au total, 94 patients (avec FA, n = 47; sans FA, n = 47) (âgés de 70 ± 8 ans) étaient inclus dans l’étude. Des améliorations significatives sur 2 des 8 sous-échelles du Physical Component Summary (sommaire du volet physique) du Short Form-36 ont été observées dans tous les groupes après la RC (p < 0,05). Des interactions significatives ont mis en évidence un effet plus marqué de la RC sur le plan de l’énergie, du bien-être émotionnel, du fonctionnement social, de la douleur et du Physical Component Summary chez les patients sans FA (p < 0,05 pour chacune). Aucune amélioration significative de l’anxiété (avec FA : -1,3 ± 3,4; sans FA : -1,3 ± 4,3), de la dépression (avec FA : -1,1 ± 2,9; sans FA : -0,4 ± 2,7), de l’indice de masse corporelle (avec FA : -0,5 ± 1,2; sans FA : -0,8 ± 1,5, kg/m2), du tour de taille (avec FA : -1,7 ± 4,6; sans FA : 0,4 ± 8,1, cm), ou de la pression artérielle (avec FA : -2,3 ± 17,1/-3,9 ± /9,3; sans FA : 1,8 ± 16,4/-0,8 ± /9,3 mmHg) n’a été observée dans les groupes après la RC.

      Conclusions

      La RC a amélioré la QdV de façon plus marquée chez les patients atteints de cardiopathie sans FA que chez ceux présentant une FA persistante ou permanente.
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