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S148 Abstracts Heart, Lung and Circulation2008;17S:S1–S209

doi:10.1016/j.hlc.2008.05.350

350The Nature and Duration of Worsening Heart FailureSymptoms and Contacts Made Prior to Hospitalisation

Robyn Gallagher 1,∗, Anne Sullivan 2, Susan Hales 2,Geraldine Gillies 2, Vanessa Baker 2, Geoffrey Toffler 2

1 University of Technology, Sydney, Sydney, NSW, Australia;2 Northern Sydney Central Coast Area Health Service, Sydney,NSW, Australia

Introduction: Early recognition and timely intervention for

and decision-making during the pre-admission period isrequired.

doi:10.1016/j.hlc.2008.05.351

351A Personalised Exercise Program for Patients with BothSystolic and Diastolic Heart Failure is Associated withImproved Functional Capacity and Quality of Life

Jeffrey Briggs ∗, Matthew Sutton, Margaret Arstall

Lyell McEwin Hospital, Elizabeth Vale, SA, Australia

The role of exercise in the management of heart failure isbeing increasingly recognised as beneficial in improvingexercise tolerance, quality of life and measures of cardiacfunction without increasing mortality rate. As a conse-quence, exercise programs are becoming a part of themulti-faceted management of heart failure in many hospi-tals and centres that manage such patients. These patientsoften have multiple co-morbidities which also influencetheir ability to perform exercise.As part of the heart failure management program atour institution we commenced a 3 month, twice weekly,30 min, individually tailored exercise program for patientswith documented evidence of heart failure and a recentadmission with cardiac decompensation. The programwas carried out in our hospital gymnasium with eight

worsening symptoms of congestive cardiac failure (CCF)may prevent hospitalisations. This study explored the pat-tern of these symptoms and patients’ actions prior tohospitalisation.Methods: All patients enrolled in the Management of Car-diac Function (MACARF) program in Northern SydneyHealth who were hospitalised for CCF in 2007 (hospitali-sations = 448, individuals = 364), were asked about the typeand duration of common CCF symptoms and contacts withhealth professionals before hospitalisation.Results: Patients were aged 79.7 years ± s.d. 11.3 years,and male (53%), English speaking (89%) and married(45%). Approximately half (56%) contacted a health pro-fessional before hospitalisation; males (61%) more so thanfemales (49%) (p = 0.01) and were not more likely to doso for subsequent admissions. Patients experienced anaverage 2.7 symptoms (s.d. 1.4), most often increasedexertional dyspnoea (90%), oedema (48%), cough (26%)and fatigue (24%). Symptoms experienced the shortestduration (median) were increased chest discomfort (1day), increased palpitations (2 days), increased exertionaland nocturnal dyspnoea (both 3 days); while symptomsendured the longest were oedema, weight gain and fatigue(all 7 days). At second or subsequent admissions, patientspresented significantly earlier for exertional dyspnoea,cough, fatigue and with chest discomfort than the firstadmission. However, this sample excludes patients whosought intervention and avoided admission.Conclusion: CCF patients frequently tolerate worsen-ing symptoms without seeking appropriate medicalassistance, resulting in many potentially preventablehospitalisations. Further study of patient’s experiences

patients in each group. The program was devised andsupervised for each individual by a physiotherapist, com-bining aerobic cardiovascular and resistance training.Exercise goals and personal programs were reviewedweekly.In the first 23 patients (mean age 62 ± 12 S.D. years) whohad completed the program, 5 were female and 5 haddiastolic heart failure with a LVEF > 45%. Fifteen patientshad ischaemic heart disease (IHD) as a cause of theirheart failure. There were no deaths during the programand 2 cardiac readmissions, although neither of thesewas for decompensated heart failure. There was a signif-icant improvement in 6 min walk distance (median 35 m,95% CI: 10–61, p = 0.02), decrease in BNP (median 30, 95%CI: 16–458, p = 0.04) and improvement in decrease in thephysical score of the Minnesota Living with Heart Fail-ure (MLWHF) questionnaire (median 11, 95% CI: 8–15,p < 0.0001) and emotional score of the MLWHF question-naire (median 7, 95% CI: 4–10, p = 0.0004). There was nosignificant decrease in Body Mass Index or waist circum-ference. There was no patient group that benefited moreor less from the program.In conclusion, a twice weekly, 30 min, tailored exercise pro-gram for patients with both diastolic and systolic heartfailure offers patients a safe, significant improvement infunctional capacity and quality of life.

doi:10.1016/j.hlc.2008.05.352