Rehabilitation in Patients With Congenital Heart Disease (CARE-GUCH)

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details. Identifier: NCT01463800
Recruitment Status : Terminated (low inclusion rate)
First Posted : November 2, 2011
Last Update Posted : October 2, 2017
Information provided by (Responsible Party):
University Hospital, Basel, Switzerland

Brief Summary:
Exercise intolerance is a major burden for patients with complex congenital heart disease (CHD), significantly affecting their quality of life. Cardiopulmonary exercise testing provides a reliable tool both for assessing exercise capacity of CHD patients and for risk stratification and is becoming part of the routine clinical assessment of these patients. Exercise has an effect on the muscular, metabolic and circulatory systems. While exercise training has been widely studied in chronic heart failure, its efficacy in adults with CHD remain unknown. The investigators hypothesize that structured exercise training will improve exercise intolerance, in particular peak VO2. The aim of this multicenter, randomized study is to evaluate the impact of structured exercise training on exercise intolerance in patients with complex CHD.

Condition or disease Intervention/treatment Phase
Heart Defects, Congenital Behavioral: Structured exercise training Not Applicable

Detailed Description:

This is a randomized, prospective, multicenter, interventional study.

After study patients have given written consent they will be randomized either in the interventional group with a rehabilitation program or in the control group without rehabilitation program. Patients who are randomized in the control group are allowed to perform the rehabilitation program 12 months after randomisation. Patients in the interventional group will perform structured exercise training on 3 weekdays during a 12-weeks period. Training will be performed by ergometer and low-impact gymnastic and relaxation training.

All study participants have the following investigations at the beginning of the study and after 12 weeks:

  • Cardiopulmonary exercise testing with spirometry
  • 6-minute walk test
  • Blood work: BNP, Creatinine, Sodium, Potassium, Urat, Cholesterol (HDL-L and LDL-L)
  • Validated Heart failure questionnaires (SF-36 and Minnesota Living with heart failure questionnaire, German version for Basel, Zürich and Bern) All tests will be repeated as clinically indicated in a follow-up visit 12 months after baseline

Primary outcome is:

Comparison of peak VO2 at the end of rehabilitation between both groups.

Secondary outcomes are:

  • Comparison of 6-min walk test, VE/VCO2 slope, anaerobic threshold and heart rate and blood pressure response after rehabilitation between both groups
  • Changes of 6-min walk test, peak VO2, VE/VCO2 slope, anaerobic threshold and heart rate and blood pressure response at the end and 12 months after rehabilitation.
  • Changes of quality-of-life assessed by validated heart failure questionnaire at the end and 12 months after rehabilitation and comparison between both groups.
  • Changes of levels of brain-natriuretic peptide at the end and 12 months after rehabilitation.
  • Adverse events during rehabilitation including new onset of arrhythmia, admission due to worsening heart failure or death.

The calculated sample size to reach a power of 0.80 is 83 patients in each arm. Patients with complex CHD and exercise intolerance are at increased risk for premature death and severe cardiac complications including arrhythmia needing treatment, heart failure and circulatory failure, pulmonary hemorrhage, pulmonary embolism and endocarditis. Hence, the likelihood of major adverse cardiac events during the study phase is considerably high. However, there is no evidence of functional worsening by low-level exercise. Smaller studies with patients with congenital heart disease and/or pulmonary hypertension did not report safety issues. Although sudden cardiac death is one of the leading modes of death in this population, it is extremely rare that sudden death occurs during exercise. Cardiac patients who are at specific risk for exercise-induced arrhythmia are not included into the study (i.e. patients with hypertrophic obstructive cardiomyopathy).

Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 28 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)
Primary Purpose: Supportive Care
Official Title: Cardiac Rehabilitation in Patients With Complex Congenital Heart Disease: Improvement of Exercise Intolerance
Study Start Date : May 2011
Actual Primary Completion Date : May 2016
Actual Study Completion Date : January 1, 2017

Resource links provided by the National Library of Medicine

Arm Intervention/treatment
Active Comparator: Structured Exercise training
12 weeks ambulatory low level exercise training
Behavioral: Structured exercise training
12 weeks low level ambulatory structured exercise training

No Intervention: Control group
No structured exercise training

Primary Outcome Measures :
  1. peak VO2 [ Time Frame: 12 weeks ]
    Comparison between both groups

Secondary Outcome Measures :
  1. 6 minute walk test [ Time Frame: 12 weeks ]
    between both groups and within groups

  2. VE/VCO2 [ Time Frame: 12 weeks ]
    Comparison between groups and within groups

  3. heart rate response [ Time Frame: 12 weeks ]
    Difference between peak heart rate and resting heart rate Comparison between groups and within groups

  4. QoL [ Time Frame: 12 weeks ]
    Comparison between groups and within groups Minnesota Heart failure Score and SF 36

  5. BNP [ Time Frame: 12 weeks ]
    Comparison between groups and within groups

  6. Adverse events [ Time Frame: 12 weeks ]
    cardiac related adverse events including cardiac death

  7. peak VO2 [ Time Frame: 12 months ]
    Comparison between groups and within groups

  8. VE/VCO2 [ Time Frame: 12 months ]
    Comparison between groups and within groups

  9. Heart rate response [ Time Frame: 12 months ]
    Comparison between groups and within groups

  10. 6 minute walk test [ Time Frame: 12 months ]
    Comparison between groups and within groups

  11. QoL [ Time Frame: 12 months ]
    Comparison between groups and within groups

  12. BNP [ Time Frame: 12 months ]
    Comparison between groups and within groups

  13. Cardiac adverse events [ Time Frame: 12 months ]
    Comparison between groups and within groups

Information from the National Library of Medicine

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Ages Eligible for Study:   18 Years and older   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No

Inclusion Criteria:

  1. Patients with complex CHD including cyanotic heart disease, subaortic right ventricle physiology, single ventricle physiology, Ebstein anomaly with ≥ moderate tricuspid regurgitation and patients with Tetralogy of Fallot (including those with pulmonary atresia of Fallot type or double-outlet right ventricle of Fallot type) and either residual free pulmonary regurgitation or left- or right ventricular systolic dysfunction (demonstrated by echocardiography or cardiac MRI).
  2. Peak VO2 < 85% of predicted (standardized for age, gender, weight and height) obtained by cardiopulmonary exercise testing
  3. Sedentary lifestyle (< 30 minutes of regular exercise per week)

Exclusion Criteria:

  1. Patients with dyspnea New York Heart Association (NYHA) class IV.
  2. Severe left ventricular outflow tract obstruction.
  3. Unstable angina or recent myocardial infarction (<12 months).
  4. Uncontrolled ventricular arrhythmia.
  5. Recent intervention (<12 months)
  6. Life expectancy <12 months
  7. No consent.

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its identifier (NCT number): NCT01463800

Virgen Macarena University Hospital
Sevilla, Spain
University Hospital Basel
Basel, Switzerland, 4052
Inselspital Bern
Bern, Switzerland, 3010
University Hospital Zurich
Zurich, Switzerland, 8091
Sponsors and Collaborators
University Hospital, Basel, Switzerland
Principal Investigator: Daniel Tobler, MD University Hospital, Basel, Switzerland

Responsible Party: University Hospital, Basel, Switzerland Identifier: NCT01463800     History of Changes
Other Study ID Numbers: CARE-GUCH
First Posted: November 2, 2011    Key Record Dates
Last Update Posted: October 2, 2017
Last Verified: September 2017

Keywords provided by University Hospital, Basel, Switzerland:
Heart Defects, congenital

Additional relevant MeSH terms:
Heart Diseases
Heart Defects, Congenital
Congenital Abnormalities
Cardiovascular Diseases
Cardiovascular Abnormalities