LAUSR

BACKGROUND Predicting prognosis in heart failure (HF) is of major importance. AIM The aim of the study was to define predictors influencing long-term cardiovascular mortality or HF hospitalization ("composite outcome") based on clinical status and measurements obtained after the 9-week hybrid comprehensive telerehabilitation (HCTR) program. METHODS This analysis is based on TELEREH-HF (TELEREHabilitation in Heart Failure) multicenter, randomized trial that enrolled 850 HF patients (left ventricular ejection fraction [LVEF]≤40%). Patients were randomized 1:1 to 9-week HCTR plus usual care (development sample) or usual care only (validation sample) and followed for median 24 months (Q1:20 Q3:24) for development of the composite outcome. RESULTS Over 12-24 months of follow-up 108 (28.1%) patients experienced the composite endpoint. The predictors of our composite outcome were: non-ischaemic etiology of HF, diabetes, higher serum level of: N-terminal prohormone of brain natriuretic peptide, creatinine, and high-sensitivity C-Reactive Protein; low carbon dioxide output atpeak exercise, high minute ventilation and breathing frequency at maximum effort in cardiopulmonary exercise test; increase of delta of average heart rate in 24h-ECG Holter monitoring, lower LVEF and patients' non-adherence to HCTR. The model discrimination C-index=0.795 and decreased to 0.755 on validation conducted in the control sample which was not used in derivation. The 2-year risk of the composite outcome was 48% in the top tertile versus 5% in the bottom tertile of the developed risk score. CONCLUSION Risk factors collected at the end of the 9-week telerehabilitation period performed well in stratifying patients based on their 2-year risk of the composite outcome. Patients in the top tertile had an almost ten-fold higher risk compared to patients in the bottom tertile. Adherence to treatment but not peakVO₂ or quality of life were significantly associated with the outcome.