Abstract 10415: Predicting Mortality in Advanced Heart Failure and Chronic Obstructive Pulmonary Disease Following Cardiopulmonary Rehabilitation

• Published in: Circulation (New York, N.Y.) N.Y.), 2018-11, Vol.138 (Suppl_1 Suppl 1), p.A10415-A10415
• Main Authors: Dougherty, Cynthia M, Kang, Youjeong, Burr, Robert L, Steele, Bonnie G
• Format: Article
• Language: English
• ISSN: 0009-7322; 1524-4539

IntroductionCardiopulmonary rehabilitation (CR) improves physical function and quality of life in chronic obstructive pulmonary disease (COPD) and heart failure (HF) populations, but it is unknown if CR improves outcomes in very severe disease. The purpose is to describe functional capacity (6MWD, steps/day), symptoms (dyspnea, depression), quality of life (SF-36V) and cardiopulmonary function (NT_Pro BNP, FEV1) over 1 year, and derive predictors of mortality among patients with severe COPD and HF who participated in CR.HypothesisBaseline predictors of mortality following CR would be similar among HF and COPD groups and useful for future CR referrals.MethodsThis study was a secondary analysis of a randomized clinical trial that compared 2 methods of CR in severe COPD and HF. Neither form of CR resulted in significant improvement in outcomes for either group. Trajectories of functional capacity, symptoms, quality of life, and cardiopulmonary function were compared over 1 year between COPD vs. HF, and with a group who died (mortality group) within 1 year of participation into CR. Trajectories were created using longitudinal generalized estimating equations (GEE). Predictors of mortality using baseline characteristics were created using multivariate logistic regression.ResultsNinty (COPD=63 HF=27) male veterans, mean age 66±9.24 years, 79% Caucasian, BMI 31 kg/m were followed for 12 months after CR. The COPD group had greater functional decline than the HF group (6MWD, Wald X=10.4, p=.006). Dyspnea symptoms were lower (Wald X=3.51, p=0.001) and quality of life higher (Wald X=4.10, p=0.006) in HF, than COPD. Mean NT_proBNP was higher in the HF group at all time points. FEV1 was improved over 12 months in both groups (Wald X=8.23, p=.02). Mortality was 8.9% at 12 months, 16.7% at 24 months, and 37.8% at 60 months. One year predictors of mortality for both groups were baseline total steps (