Cardiac Rehabilitation in Obesity-related Heart Failure With Preserved Ejection Fraction

• Published in: Obesity (Silver Spring, Md.) Md.), 2022-11, Vol.30, p.144-145
• Main Authors: Khor, Lillian, Bailey, Kelsey, Dickey, Jacqueline
• Format: Article
• Language: English
• Subjects: Cardiovascular disease; Diuretics; Ejection fraction; Gastrointestinal surgery; Heart failure; Obesity; Rehabilitation; Weight control
• ISSN: 1930-7381; 1930-739X

Background: Patients with obesity have an increased risk for heart failure with preserved ejection fraction (HFpEF), associated with significant healthcare utilization. The growing prevalence of obesity related HFpEF and cardiometabolic and hemodynamic derangements associated with low exercise capacity (EC) are therefore of clinical and socioeconomic significance. Cardiac rehabilitation (CR) is an effective multi-disciplinary intervention which is not reimbursed by Centers for Medicare and Medicaid Services (CMS) for the indication of HFpEF. Our CR program has created an out-of-pocket program for HFpEF to address this underserved population. We aimed to assess the weight loss and EC improvement associated with CR, weight loss medications, diuretics, and bariatric surgery. Methods: We conducted a retrospective analysis on nineteen patients with HFpEF and obesity enrolled in our phase III CR program between January to July 2022, at an out-of-pocket cost of $100 per month (on average 8 sessions) or through a charity fund for those who were unable to afford the cost. We used the Redcap application to record and analyze weight change, medication use, and change in EC measured on sub-maximal graded treadmill or bicycle testing or estimated from a 6-minute-walk in metabolic equivalents (METs). Results: At orientation, participants had an average age of 71, BMI of 44.7 kg/m2 and an average EC of 3.4 METS. 10 male (52.63%) and 9 female (47.36%) participated in an average of 24 CR sessions. Their average weight loss was 33 pounds (11.4%) and EC improved by an average of 0.7 METs (20.5%). 4 patients were pre-bariatric surgery, 6 post-bariatric surgery, 9 were on weight loss medications, and 13 on diuretics. Conclusions: CR is an effective, adjunctive therapy for patients with obesity-related HFpEF and is associated with significant weight loss and EC improvement. Further study on its impact on quality of life, hospital admissions, and survival is warranted.