https://doi.org/10.1007/s00392-025-02625-4
1Thoraxklinik - Heidelberg gGmbH Pneumologie und Beatmungsmedizin / Zentrum für Pulmonale Hypertonie Heidelberg, Deutschland; 2Universitätsklinikum Heidelberg Thoraxklinik Heidelberg, Deutschland
Background: Beneficial effects of a specialized exercise rehabilitation training program for patients with pulmonary hypertension (PH) have already been shown for exercise capacity, quality of life, symptoms and hemodynamics. Analyses on long-term disease outcome and survival are still lacking.
Objective: Aim of this study was to evaluate whether there are differences in survival in patients participating in the exercise training program vs. patients never participated.
Methods: Adult patients who received the rehabilitation program were matched to control subjects by age, sex, disease duration and WHO functional class at baseline. Clinical, echocardiographic, laboratory, exercise and hemodynamic parameters from baseline visits and follow-up visits were retrospectively analyzed. The primary endpoint was the survival of patients with rehabilitation vs. patients without.
Results: In total, 258 patients (age 61 ± 13.1 years, 60.5% female) with 129 matched pairs of patients with and without rehabilitation were included. During follow-up, 53 (41%) subjects of the control group (mean survival 4.8 years ± 0.28 standard error) and 41 (31%) subjects of the training group (mean survival 8.7 years ± 0.35 standard error) died (Figure 1). Survival of patients taking part in the exercise rehabilitation was significantly greater compared to the control group (log-rank test p<0.001). Survival probability after 4 years in the rehabilitation group was 87% and 59% for the group without rehabilitation.
Patients undergoing exercise training had a significant reduction of NT-proBNP (p=0.045) after three months compared to control subjects.
Conclusion: This study supports the hypothesis of better survival in PH patients with rehabilitation vs. those without. Selection bias for training participation despite matching patients by disease severity cannot be excluded.
Figure 1: Survival in pulmonary hypertension patients with and without rehabilitation