Heart Failure Clinical Trial
Official title:
Feasibility of Cardiac Rehabilitation in Patients With Heart Failure at the Moi Teaching and Referral Hospital
This is a study to find out whether cardiac rehabilitation is feasible in Western Kenya.
This study will test whether cardiac rehabilitation is feasible by measuring how many
participants are able to follow and complete two different exercise protocols; one at home
and one in hospital. It will also measure how the exercise intervention affects quality of
living, depression and improvement in exercise tolerance.
Cardiovascular diseases are major drivers of global disease burden. Heart failure, has a 50%
mortality at 5 years and is thought to be higher in resource limited settings. Cardiac
rehabilitation (CR) is a multi-disciplinary intervention which has been demonstrated to
improve functional status, quality of life, and reduce morbidity and mortality in patients
with heart failure. In sub-Saharan Africa, despite a significant heart failure disease
burden, CR is largely non-existent. There is a compelling need for urgent development of
access to CR in the region. However, feasibility and potential utilization of CR is unknown.
The investigators aim to conduct a mixed methods study to evaluate feasibility of home based
and institution based CR.
Participants will be voluntarily recruited from a convenience sample at the Moi Teaching and
Referral Hospital (MTRH) outpatient cardiology clinic. Based on a reasonable estimate of
expected subject recruitment over the time frame of study, 25 patients will be recruited into
the institution based cardiac rehabilitation (IBCR) arm. In consideration of the potentially
larger population and a wider geographical spread of home based cardiac rehabilitation
(HBCR), 36 patients will be recruited to the HBCR arm and 40 patients will be recruited into
an observational arm. While the study is not designed to make comparative outcome inferences
between the HBCR and the IBCR groups, the sample size will be large enough to detect a
clinically significant mean post intervention increase in 6 minute walk time distance in the
HBCR arm of 50m.
The participants will be involved in physical exercises, nutritional counseling and
educational sessions. Upon completion of the rehabilitation protocols, patients from both
study arms will also be invited to participate in focus group discussions. Data will be
analyzed and numeric data will be expressed as number (percent), means (standard deviation)
or median (interquartile range). Wilcoxon rank-sum and Fisher's exact tests for pre - post
intervention comparisons of continuous and binary variables, respectively. Focus group
discussions will be transcribed and analyzed to identify discussion themes.
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