Feasibility of Cardiac rehabilitation in Patients with Heart Failure at the Moi Teaching and Referral Hospital

Background: Cardiovascular diseases form a large part of a growing pandemic of non-communicable diseases afflicting Sub-Saharan Africa(1–3) Heart failure is one of the most debilitating of these diseases. The global 5-year life expectancy of patients afflicted by heart failure is less than 50%(4–6). Cardiac rehabilitation (CR) has been demonstrated to improve functional status, quality of life, and reduce depression in patients with heart failure(7,8). Even though CR is a simple and comparatively low-cost intervention, adherence rates of CR remains poor and are estimated at 20% in the US(9–11). In Western Kenya, CR is non-existent. We sought to establish the feasibility of two different models of cardiac rehabilitation for heart failure in Western Kenya and to identify potential barriers to participation.

Methods: This was a feasibility study using mixed methods to describe characteristics and changes in a cohort of patients with heart failure. Study participants were prospectively recruited and allocated by convenience into an institution based cardiac rehabilitation (IBCR) arm, a home based cardiac rehabilitation (HBCR) arm and an observational arm (OA). At completion of 3 month follow up period, participants were invited to take part in focus group discussions exploring perspectives on heart failure and cardiac rehabilitation. The primary measure of feasibility was the ability of study participants to attain a mean adherence rate of at least 25%, of prescribed rehabilitation sessions.

Results: This study found that cardiac rehabilitation is a feasible intervention for patients with heart failure in Western Kenya with an adherence rate of 46% for institutional based cardiac rehabilitation and an adherence rate of 28% for home based cardiac rehabilitation. All study arms demonstrated significant change in depression screening and quality of life scores. Participants in focus group discussions identified competing interests, distance to the facility and forgetfulness as barriers to cardiac rehabilitation.

Conclusions: Cardiac rehabilitation is a feasible treatment intervention for heart failure in Western Kenya. However, the barriers to delivery of care are similar to barriers in other health systems around the world(12). There is need for further research to evaluate the efficacy of cardiac rehabilitation and development of innovative ways to improve treatment adherence.