Cardiac rehabilitation in chronic heart failure patients: data from the italian survey on cardiac rehabilitation (ISYDE)

Background: Data from the Italian SurveY on carDiac rEhabilitation (ISYDE-2008) provide insight into the level of implementation of Cardiac Rehabilitation (CR) in patients with chronic heart failure (CHF). Methods: Data from 165 CR units were collected online from January 28th to February 10th, 2008. Results: The study cohort consisted of 2281 patients (66.911.8 yrs); 285 (71.312.2 yrs, 66% male) CHF patients and 1996 (66.311.6 yrs, 74% male) non-CHF patients. Compared to non-CHF, CHF patients were older, showed more comorbidity, and had a lower left ventricular ejection fraction (EF). During the course of CR, CHF patients had reduced access to functional evaluation, underwent more complications, and had less secondary prevention information and a longer length of in-hospital stay. CHF patients were also more likely transferred to intensive care units (9% versus 3%, p < 0.0001), and less likely discharged at home (85% versus 92%, p < 0.0001), respectively, compared to non-CHF patients. Discharge medications were significantly different in CHF as compared to non-CHF patients. Finally, CHF patients had higher death rate during CR programs (1.7% versus 0.5%, p¼0.01). After adjusting for age, ejection fraction, comorbidity and complications during CR program, multivariate logistic analysis showed that respiratory insufficiency (OR 2.3, 95% CI, 1.3-4.1, p¼0.002), acute kidney insufficiency or worsening chronic kidney disease (OR 2.9, 95% CI, 1.5-5.6, p¼0.001) and cognitive impairment (OR 3.7, 95% CI, 2.0-6.7, p < 0.001) were significant predictors of death in CHF patients. Conclusions: The ISYDE-2008 survey provided a detailed snapshot of CR in CHF patients, and confirmed the complexity and the differences in clinical presentation and course of CHF patients entering CR programs.