Cardiac rehabilitation in adult congenital heart disease
P Rueter, M Ahmed, R Zecchin, A R Denniss, D Tanous, M Hollings, C Dickson, P ChoudharyAbstract
Introduction
Adults with congenital heart disease (ACHD) are a growing population with distinct functional limitations and often require multiple lifetime interventions. While cardiac rehabilitation is well established in acquired heart disease, its role in ACHD remains underexplored.
Aim
To evaluate the safety and effectiveness of cardiac rehabilitation in ACHD patients including improvements in exercise capacity, quality of life (QoL) and emotional distress symptoms.
Methods
This retrospective cohort study included 213 people with ACHD that completed an outpatient cardiac rehabilitation program at a single tertiary centre between 1994-2024. Peak exercise capacity was assessed by treadmill graded exercise testing (METs) or 6-minute walk test (6MWT). QoL and emotion distress symptoms were measured using Short Form-36 (SF-36) and Depression Anxiety Stress Scales-21 (DASS-21) questionnaires. Subgroup analyses examined program outcomes based on ESC ACHD severity and lesion types. Data were analysed using SPSS with paired sample T-testing and ANOVA as appropriate.
Results
Participants were aged 50.2 ± 16.5 years, 23.4% female sex, with 43% classified as simple, 51% moderate and 6% complex ACHD. There were no adverse events during exercise testing or training. Peak exercise capacity significantly increased on treadmill tests post cardiac rehabilitation by 3.0 METs (95% Confidence Interval (CI), 2.7-3.3, p<0.05) and 6MWT by 75.1 metres (95% CI, 46.7-103.5, p<0.05). SF-36 scores improved significantly across all domains, with the greatest change seen in role limitations due to physical health (+45, 95% CI, 38.5-51.5, p<0.05) and physical functioning (+23.0, 95% CI: 19.9-26.1, p<0.05). DASS-21 scores also improved; notably anxiety (+2.4, 95% CI, 1.3-3.4, p<0.05), stress (+1.7, 95% CI, 0.6-2.8, p<0.05) and depression (+1.6, 95% CI, 0.5-2.7 p<0.05). Subgroup analyses showed no effect of ACHD severity or lesion types.
Conclusion
Cardiac rehabilitation in ACHD produced clinically relevant improvements in peak exercise capacity and patient-reported outcomes, regardless of lesion type or severity. There were no associated adverse events.