Do standard cardiac rehabilitation programs fail patients with atrial fibrillation?

October 23, 2018

Cardiac rehabilitation is not routinely recommended for patients suffering from atrial fibrillation (AF), a growing epidemic and debilitating heart condition which affects approximately 350,000 Canadians. Patients with AF often experience poor exercise tolerance, low fitness levels, poor mental health, and other disabling symptoms, such as shortness of breath, excess sweating, and difficulty sleeping.

While the benefits of cardiac rehabilitation programs are well established for patients with other types of heart disease, current clinical guidelines for treating patients with AF do not include referral to rehab programs.

I thought it was a bit concerning that we didn't have enough data regarding the impact of cardiac rehabilitation in patients with atrial fibrillation.

- Jennifer Reed, PhD

Dr. Jennifer Reed, a scientist in the Division of Cardiac Prevention and Rehabilitation and Director of the Exercise Physiology and Cardiovascular Health Laboratory at the University of Ottawa Heart Institute, is the author of a provocative new study examining the impact of cardiac rehabilitation on changes in quality of life, mental health and cardiometabolic health indicators in patients with or without persistent or permanent AF. The study, titled The Impact of Cardiac Rehabilitation on Mental and Physical Health in Patients with Atrial Fibrillation: A Matched Case-Control Study, is published by the Canadian Journal of Cardiology.

“I thought it was a bit concerning that we didn't have enough data regarding the impact of cardiac rehabilitation in patients with atrial fibrillation,” said Dr. Jennifer Reed at the Canadian Cardiovascular Congress (CCC) in Toronto. “This area [of research] is definitely growing but I think we could do a lot more.”

Reed discussed her research at the CCC.

Reed and her team conducted a matched retrospective case-control study in which patients attended a standard cardiac rehabilitation program at the Heart Institute which addressed risk factor management, and provided support services and exercise training twice-weekly for three months. Body mass index, 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 three months follow-up.

“We looked at patients with and without atrial fibrillation who completed [the Heart Institute’s] cardiac rehab program and compared them to evaluate their improvements on mental and physical health,” explained Reed. In total, 94 patients were studied, 47 with, and 47 without AF.

The study revealed that patients with AF do achieve improvements in quality of life, but not to the same extent as those without. “If you don't have atrial fibrillation, you achieve significantly greater gains in quality of life,” said Reed of the study findings. In other words, if you're a heart disease patient without AF you will benefit to a greater degree with regards to quality of life than a patient who has this condition.

Dr. Reed said larger scale trials will be necessary to evaluate the impact of cardiac rehabilitation on the quality of life of those with AF.