Safety and efficacy of an early home-based walking program after receipt of an initial implantable cardioverter defibrillator (ICD)

Publication date: Available online 3 March 2016
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Emily T. Lau, Elaine A. Thompson, Robert L. Burr, Cynthia M. Dougherty
ObjectiveTo investigate the safety and efficacy of an early, home-based walking program for first time implantable defibrillator (ICD) recipients.DesignBefore-after, intervention trial. Data from baseline and 3 months post-ICD implant.SettingInstitutional and private practice.ParticipantsInclusion criteria were cardiac patients (N=301) with an initial ICD for primary or secondary prevention, English proficient, telephone access. Exclusion criteria included Short BLESSED > 6, age < 21 years, AUDIT-C > 4, or ASSIST 2.0 > 4.InterventionEarly home-based walking protocol implemented 1 month post-ICD implant. Exercise tolerance monitored by study nurses via telephone.Main Outcome MeasuresSafety assessment was based on frequency of ICD therapies and hospitalizations, efficacy was based on pedometer measures and self-report of ICD self-efficacy and physical activity.ResultsICD recipients were on average 64.1+11.9 years old, predominantly male and Caucasian, with EF% < 35% and average Charlson score of 2.3+1.5. Nineteen individuals (6.3%) received 28 ICD shocks; 15 (53.6%) were appropriate and 13 (46.4%) inappropriate. ATP therapies were delivered 72 times in 18 (6%) individuals, with 61 (84.7%) appropriate and 11 (15.3%) inappropriate. Five ICD shocks (2 appropriate/3 inappropriate) and 2 ATP therapies occurred during walking. Seven participants (2%) were hospitalized for an ICD shock, none of which was associated with walking. Average steps/day increased by 806 over 3 months. Perceived exercise self-efficacy improved significantly as did weekly exercise. Predictors of receiving any ICD shock were younger age (p<0.0001), moderate to severe renal disease (p=0.001), and lymphoma (p=0.024).ConclusionsEarly ambulation following an initial ICD was safe and effective, with few ICD shocks and improved efficacy.



from Rehabilitation via xlomafota13 on Inoreader http://ift.tt/1LBiemt
via IFTTT