The Pivotal Role of an Early Post-Acute Cardiac Rehabilitation as an Evidence-Based Management of Left Ventricular Assist Device Patients

Background

Left Ventricular Assist Device (LVAD) implantation is an important treatment option for patients with advanced CHF. Referral to an early, intensive cardiac rehabilitation (CR) program in these patients seems still underused. This observational descriptive study aimed to evaluate the feasibility and efficacy of an early intensive CR program in LVAD recipients, also comparing results with a matched group of advanced HFrEF patients.

Methods

The study involved patients with LVAD implantation due to HFrEF who were admitted to our intensive post-acute CR program from several surgery wards from 2009 to 2023. They underwent a twice-a-day individualized exercise program and physiotherapeutic treatment, according to clinical stability and functional assessment. The study exclusively focused on the in-hospital rehabilitation period and documented cardiac and non-cardiac complications, including the Hemocompatibility-Related Adverse Events (HRAEs). The Barthel index (BI) was used to assess functional recovery from admission to discharge. Results in a subgroup of 210 LVAD patients matched on a 1:1 basis with an HFrEF population were also analyzed.

Results

One patient died during the inward rehabilitation period (respiratory failure). The majority (70.0%) of patients improved their disability (BI 67 ± 24 to 84 ± 23, p < 0.001). HRAEs occurred in 25 patients (9.1%). Compared to the HFrEF group, LVAD patients showed similar improvement in disability (p = 0.54).

Conclusions

The study suggests that an early intensive post-acute CR program can significantly improve functional capacity and disability in LVAD patients, similar to HFrEF patients admitted to the same program. Our data support scientific recommendations suggesting participation of LVAD to a CR.