[The impacts of outpatient vs inpatient holistic management based on exercise training on cardiac rehabilitation efficacy among patients with chronic heart failure].

Objective: To evaluate the impacts of outpatient vs inpatient exercise training (ET) on cardiac rehabilitation efficacy among patients with chronic heart failure (CHF). Methods: Thirty six patients who were diagnosed with CHF in Beijing Rehabilitation Hospital from September 2015 to September 2018, were randomly divided into three groups: control group (n=12), outpatient ET group (n=12) and inpatient ET group (n=12). Patients in control group were treated with conventional cardiac rehabilitation without ET, patients in outpatient and inpatient ET groups were treated with holistic cardiac rehabilitation with the core of ET according to individualized exercise prescription based on cardiopulmonary exercise testing (CPET). Exercise intensity of cycle ergometer was Δ50% power above anaerobic threshold (AT), 30 min/d, 5 d/week, for 12 weeks. General information, CPET parameters, echocardiogram, 6 minute walking distance (6MWD) and quality of life (QoL) score of three groups of patients before and after treatment were recorded. Results: All patients in 3 groups finished symptom-limited CPET and patients in ET groups finished 12 weeks - ET safely without complications. Before treatment, there were no significant differences in CPET parameters, echocardiogram results, 6MWD and QoL score among 3 groups (P>0.05). After treatment, AT (ml/min, ml/(min·kg), %pred), peak oxygen uptake (VO₂) (ml/min, ml/(min·kg), %pred), peak oxygen pulse(ml/beat), peak workload(W/min, %pred), left ventricular ejection fraction (LVEF) and 6MWD of patients in outpatient and inpatient ET groups were significantly higher than those of patients in control group (P<0.05), QoL score of patients in outpatient and inpatient ET groups was lower than that of patients in control group(P<0.05). To be noted, there were no obvious differences in CPET indexes, echocardiogram results, 6MWD and QoL score in patients between outpatient ET group and inpatient ET group (P>0.05). For patients in control group, there were no significant differences in above parameters before and after treatment (P>0.05). AT(ml/min, ml/(min·kg)), Peak VO₂ (ml/min, ml/(min·kg), %pred), peak oxygen pulse(ml/beat, %pred), peak workload(W/min, %pred), LVEF and 6MWD of patients in outpatient and inpatient ET groups were significantly higher than those before treatment (P<0.05), QoL score of patients in outpatient and inpatient ET groups after treatment was significantly lower than that before treatment (P<0.05). Conclusion: Outpatient ET can improve the cardiopulmonary function, exercise tolerance and QoL of CHF patients, which has no significant difference compared with inpatient ET, indicating that outpatient cardiac rehabilitation, as an effective rehabilitation mode, is deserved to be applied widely.