Baseline Ergometry Hemodynamics May Predict Long Term Mortality in Heart Failure Patients Referred to Cardiac Rehabilitation Program

Introduction: Baseline ergometry is done routinely prior to the participation in cardiac rehabilitation programs. It serves as a safety screening measure and it is used for planning a personalized protocol for the referred Heart Failure (HF) patients.

The aim of this study was to assess whether the results of a single ergometry test hemodynamics may also assist in predicting long term mortality in HF patients referred to cardiac rehabilitation.

Methods: Clinical, demographic and ergometry hemodynamics data of 684 HF patients with NYHA 2-3 {58% reduced LVEF, 13%Mid-range and 29% preserved LVEF} who were referred to cardiac rehabilitation at Sheba Medical Center (2009-2016) were analyzed retrospectively. Mean age was 67 ± 12-year, Diabetes Mellitus (DM) was documented in 42%, coronary artery disease in 71% and history of hypertension in 63%. All patients had baseline ergometry performed prior to starting the cardiac rehabilitation program and hemodynamic results were specifically analyzed in respect of total mortality.

Results: During median follow up time of 2.5 years, mortality rates were high yet similar between the three sub-LVEF (15.6%). After uni and multi variable analysis for mortality according to clinical, demographic and ergometry hemodynamics; maximal Mets and peak SBP were found to be significant predictors of long-term total mortality. Specifically, each increase in 1 METS was associated with 12% reduction of mortality rates and each increase in 1 mmHg peak systolic pressure was associated with 1% mortality rate reduction. Older age, male gender, history of DM, hypertension and elevated creatinine were the other non-hemodynamic parameters associated with increased long-term mortality (Table 1).

Conclusions: Maximal METS and peak exercise SBP achieved in baseline ergometry tests conducted routinely upon starting cardiac rehabilitation programs, may assist in predicting patient’s long-term mortality. This routine ergometry may signal high risk HF patients predisposed to mortality even in long-term future.