Pulmonary rehabilitation in patients with group 3 pulmonary hypertension: evaluation of clinical outcomes, adherence and safety

Background: Pulmonary Rehabilitation (PR) may improve exercise tolerance and health status in patients with pulmonary hypertension groups 1 and 4 (Morris, N. et al. Cochrane database, 2017). Little is known about the effectiveness, safety or feasibility of PR in patients with group 3 pulmonary hypertension (that which is associated with lung disease), who access PR due to their underlying respiratory pathology. Aims: To describe clinical outcomes, adherence and safety in patients with group 3 pulmonary hypertension attending a standard United Kingdom-based PR programme. Method: A retrospective casenote review was conducted for patients with group 3 pulmonary hypertension attending PR over a 3-year period (2016-2019). Data included pre- and post-PR six-minute walk distance (6MWD), Medical Research Council breathlessness scale (MRC), COPD assessment test (CAT), patient health questionnaire-9 (PHQ-9) and generalised anxiety disorder-7 (GAD-7). Adherence and adverse events were collected. Results: Thirty-one patients with group 3 pulmonary hypertension were enrolled in PR. There was a significant improvement in 6MWD (median change 30m; 95%CI 5, 70m p=0.023;) and MRC (median change -1.0; 95%CI -1.0, -0.5; p=0.005) following PR but no change in CAT, PHQ-9 or GAD-7. PR completion rate was 65%. Low to medium risk adverse events did occur, most commonly, oxygen desaturation below 80%. Conclusion: In patients with group 3 pulmonary hypertension, PR is feasible and low-risk. Significant improvements in 6MWD were achieved, although the impact on health status was less clear. The occurrence of adverse events suggests the need for extra monitoring in this patient group.