Determinants and Implementation of Hybrid Cardiac Rehabilitation in Adolescents and Young Adults With Congenital Heart Disease: Insight From the QUALIREHAB Study.

BACKGROUND

The QUALIREHAB (Cardiac Rehabilitation in Youth With Congenital Heart Disease) trial demonstrated the efficacy of a hybrid cardiac rehabilitation model in adolescents and young adults with congenital heart disease. This post hoc mixed-methods study aimed to identify baseline predictors of clinical improvement and to characterize key components supporting implementation and scalability.

METHODS

Seventy participants aged 13 to 25 years from the intervention arm were analyzed. Clinical improvement was defined as a clinically meaningful increase in cardiopulmonary fitness (increase in peak oxygen uptake ≥3.5 mL/kg per min) or health-related quality of life (Pediatric Quality of Life Inventory increase ≥4.3 points). Multivariable logistic regression models identified predictors of clinical improvement. Semistructured interviews with patients and health care professionals explored experiences, barriers, and implementation mechanisms.

RESULTS

The absence of prior cardiac surgery or interventional catheterization was independently associated with short-term improvement in peak oxygen uptake. At 1 year, male sex and lower baseline ventilatory anaerobic threshold were associated with greater peak oxygen uptake improvement. Lower baseline ventilatory anaerobic threshold was also the only predictor of clinically meaningful health-related quality of life improvement. Qualitative findings highlighted the accessibility and acceptability of the hybrid model but underscored the need for higher-intensity and more varied exercise modalities, integrated digital tools, continuous psychological support, family involvement, and structured postrehabilitation follow-up to sustain long-term benefits.

CONCLUSIONS

Among treated participants, male sex, absence of prior cardiac surgery, and marked baseline deconditioning were associated with greater clinical improvement, supporting a shift from standardized toward tailored cardiac rehabilitation in congenital heart disease. By addressing key logistical and psychosocial barriers, this scalable framework offers a pragmatic model for routine care implementation and may be transferable to other pediatric chronic conditions.

REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier: NCT03690518.