Early hybrid cardiac rehabilitation in congenital heart disease: the QUALIREHAB trial

Abstract

Background and Aims
Cardiopulmonary fitness in congenital heart disease (CHD) decreases faster than in the general population resulting in impaired health-related quality of life (HRQoL). As the standard of care seems insufficient to encourage and maintain fitness, an early hybrid cardiac rehabilitation programme could improve HRQoL in CHD.

Methods
The QUALIREHAB multicentre, randomized, controlled trial evaluated and implemented a 12-week centre- and home-based hybrid cardiac rehabilitation programme, including multidisciplinary care and physical activity sessions. Adolescent and young adult CHD patients with impaired cardiopulmonary fitness were randomly assigned to either the intervention (i.e. cardiac rehabilitation) or the standard of care. The primary outcome was the change in HRQoL from baseline to 12-month follow-up in an intention-to-treat analysis. The secondary outcomes were the change in cardiovascular parameters, cardiopulmonary fitness, and mental health.

Results
The expected number of 142 patients was enroled in the study (mean age 17.4 ± 3.4 years, 52% female). Patients assigned to the intervention had a significant positive change in HRQoL total score [mean difference 3.8; 95% confidence interval (CI) 0.2; 7.3; P = .038; effect size 0.34], body mass index [mean difference −0.7 kg/m2 (95% CI −1.3; −0.1); P = .022; effect size 0.41], level of physical activity [mean difference 2.5 (95% CI 0.1; 5); P = .044; effect size 0.39], and disease knowledge [mean difference 2.7 (95% CI 0.8; 4.6); P = .007; effect size 0.51]. The per-protocol analysis confirmed these results with a higher magnitude of differences. Acceptability, safety, and short-time effect of the intervention were good to excellent.

Conclusions
This early hybrid cardiac rehabilitation programme improved HRQoL, body mass index, physical activity, and disease knowledge, in youth with CHD, opening up the possibility for the QUALIREHAB programme to be rolled out to the adult population of CHD and non-congenital cardiac disease.

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Details

Published: Mar 02, 2024
Vol/Issue: 45(16)
Pages: 1458-1473
License: View

Authors

P

Pascal Amedro

Department of Fetal, Pediatric and Adult Congenital Cardiology, M3C National CHD Reference Centre, Bordeaux University Hospital, Haut-Leveque Hospital , Avenue de Magellan, 33604 Pessac Cedex , France; IHU Liryc, INSERM 1045, University of Bordeaux , Avenue du Haut-Leveque, 33600 Pessac , France

A

Arthur Gavotto

Pediatric and Congenital Cardiology Department, M3C Regional Reference CHD Centre, Montpellier University Hospital , Montpellier , France; PhyMedExp, INSERM, CNRS, University of Montpellier , Montpellier , France

H

Helena Huguet

Epidemiology and Clinical Research Department, University Hospital, University of Montpellier , Montpellier , France

L

Luc Souilla

PhyMedExp, INSERM, CNRS, University of Montpellier , Montpellier , France

A

Anne-Cecile Huby

Department of Fetal, Pediatric and Adult Congenital Cardiology, M3C National CHD Reference Centre, Bordeaux University Hospital, Haut-Leveque Hospital , Avenue de Magellan, 33604 Pessac Cedex , France; IHU Liryc, INSERM 1045, University of Bordeaux , Avenue du Haut-Leveque, 33600 Pessac , France

S

Stefan Matecki

PhyMedExp, INSERM, CNRS, University of Montpellier , Montpellier , France

A

Anne Cadene

Epidemiology and Clinical Research Department, University Hospital, University of Montpellier , Montpellier , France

G

Gregoire De La Villeon

Pediatric and Congenital Cardiology Department, M3C Regional Reference CHD Centre, Montpellier University Hospital , Montpellier , France; Pediatric Cardiology and Rehabilitation Unit, St-Pierre Institute , Palavas-Les-Flots , France

M

Marie Vincenti

Pediatric and Congenital Cardiology Department, M3C Regional Reference CHD Centre, Montpellier University Hospital , Montpellier , France; PhyMedExp, INSERM, CNRS, University of Montpellier , Montpellier , France; Pediatric Cardiology and Rehabilitation Unit, St-Pierre Institute , Palavas-Les-Flots , France

O

Oscar Werner

Pediatric and Congenital Cardiology Department, M3C Regional Reference CHD Centre, Montpellier University Hospital , Montpellier , France; Pediatric Cardiology and Rehabilitation Unit, St-Pierre Institute , Palavas-Les-Flots , France

C

Charlene Bredy

Pediatric and Congenital Cardiology Department, M3C Regional Reference CHD Centre, Montpellier University Hospital , Montpellier , France; Fontfroide Cardiac Rehabilitation Center , 1800 rue de Saint-Priest, 34097 Montpellier , France

K

Kathleen Lavastre

Pediatric and Congenital Cardiology Department, M3C Regional Reference CHD Centre, Montpellier University Hospital , Montpellier , France

H

Hamouda Abassi

Pediatric and Congenital Cardiology Department, M3C Regional Reference CHD Centre, Montpellier University Hospital , Montpellier , France; PhyMedExp, INSERM, CNRS, University of Montpellier , Montpellier , France

S

Sarah Cohen

Pediatric and Congenital Cardiology Department, M3C National Reference CHD Centre, Marie-Lannelongue Hospital , Le Plessis-Robinson , France

S

Sébastien Hascoët

Pediatric and Congenital Cardiology Department, M3C National Reference CHD Centre, Marie-Lannelongue Hospital , Le Plessis-Robinson , France

C

Claire Dauphin

Pediatric and Congenital Cardiology Department, M3C Regional Reference CHD Centre, Clermont-Ferrand University Hospital , Clermont-Ferrand , France

A

Aurelie Chalard

Pediatric and Congenital Cardiology Department, M3C Regional Reference CHD Centre, Clermont-Ferrand University Hospital , Clermont-Ferrand , France

Y

Yves Dulac

Pediatric and Congenital Cardiology Department, M3C Regional Reference CHD Centre, Toulouse University Hospital , Toulouse , France

N

Nathalie Souletie

Pediatric and Congenital Cardiology Department, M3C Regional Reference CHD Centre, Toulouse University Hospital , Toulouse , France

H

Hélène Bouvaist

Pediatric and Congenital Cardiology Department, M3C Regional Reference CHD Centre, Grenoble University Hospital , Grenoble , France

S

Stephanie Douchin

Pediatric and Congenital Cardiology Department, M3C Regional Reference CHD Centre, Grenoble University Hospital , Grenoble , France

M

Matthias Lachaud

Pediatric and Congenital Cardiology Department, M3C Regional Reference CHD Centre, Grenoble University Hospital , Grenoble , France

C

Caroline Ovaert

Pediatric and Congenital Cardiology Department, M3C Regional Reference CHD Centre, APHM La Timone Hospital , Marseille , France

C

Camille Soulatges

Pediatric and Congenital Cardiology Department, M3C Regional Reference CHD Centre, APHM La Timone Hospital , Marseille , France

N

Nicolas Combes

Pediatric and Congenital Cardiology Department, Pasteur Clinic , Toulouse , France

J

Jean-Benoit Thambo

Department of Fetal, Pediatric and Adult Congenital Cardiology, M3C National CHD Reference Centre, Bordeaux University Hospital, Haut-Leveque Hospital , Avenue de Magellan, 33604 Pessac Cedex , France; IHU Liryc, INSERM 1045, University of Bordeaux , Avenue du Haut-Leveque, 33600 Pessac , France

X

Xavier Iriart

Department of Fetal, Pediatric and Adult Congenital Cardiology, M3C National CHD Reference Centre, Bordeaux University Hospital, Haut-Leveque Hospital , Avenue de Magellan, 33604 Pessac Cedex , France

F

Fanny Bajolle

Pediatric and Congenital Cardiology Department, M3C National Reference CHD Centre, APHP Necker Hospital , Paris , France

D

Damien Bonnet

Pediatric and Congenital Cardiology Department, M3C National Reference CHD Centre, APHP Necker Hospital , Paris , France

H

Helene Ansquer

Pediatric and Congenital Cardiology Department, Brest University Hospital , Brest , France

J

Jean-Guillaume Delpey

Pediatric and Congenital Cardiology Department, Brest University Hospital , Brest , France

L

Laurence Cohen

Fetal, Pediatric and Congenital Private Practice , 8 rue du Conseil de l'Europe, 91300 Massy , France

M

Marie-Christine Picot

Epidemiology and Clinical Research Department, University Hospital, University of Montpellier , Montpellier , France; Clinical Investigation Centre, INSERM-CIC 1411, University of Montpellier , Montpellier , France

S

Sophie Guillaumont

Pediatric and Congenital Cardiology Department, M3C Regional Reference CHD Centre, Montpellier University Hospital , Montpellier , France; Pediatric Cardiology and Rehabilitation Unit, St-Pierre Institute , Palavas-Les-Flots , France

Congenital and Pediatric Cardiology, Adult Congenital Heart Disease Unit, Hôpital Européen Georges Pompidou , Paris ,; Adult Congenital Heart Disease Unit, Hôpital Européen Georges Pompidou, Assistance Publique des Hôpitaux de Paris, Paris Cité University , Paris ,

Frederique Sidney-Hetmaniak

Funding

French Ministry of Health

Saint-Pierre Foundation

APARD healthcare provider

Cite This Article

Pascal Amedro, Arthur Gavotto, Helena Huguet, et al. (2024). Early hybrid cardiac rehabilitation in congenital heart disease: the QUALIREHAB trial. European Heart Journal, 45(16), 1458-1473. https://doi.org/10.1093/eurheartj/ehae085

Early hybrid cardiac rehabilitation in congenital heart disease: the QUALIREHAB trial

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