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Tailored Rehabilitation Program for Older Patients With HF
Study Questions:
What is the impact of a novel physical rehabilitation intervention in older patients hospitalized for acute decompensated heart failure (ADHF)?
Methods:
The study cohort was comprised of ADHF patients >60 years of age in whom a novel physical rehabilitation program was initiated in the hospital and continued for 12 weeks post-discharge. The REHAB-HF (Rehabilitation Therapy in Older Acute Heart Failure Patients) pilot study was a three-site, randomized, attention-controlled study where the goal of the intervention program was to improve performance in four domains: balance, strength, mobility, and endurance. Exercise prescription was then adapted to individual functional deficits in each domain using standardized protocols. Participants randomized to the attention control group received at least monthly contact from study personnel with scheduled phone calls (months 2, 4, 5, and 6) and follow-up assessments (months 1 and 3). The primary aim of the study was to determine the feasibility and reasonableness of the hypothesis that this novel approach to rehabilitation would improve physical function (Short Physical Performance Battery [SPPB]) over 3 months and reduce all-cause re-hospitalizations over 6 months. Comparison of change in SPPB at 3 months between the attention control and intervention arms was made by analysis of covariance, with the 3-month value as the outcome and the baseline value as the covariate.
Results:
The study was comprised of 27 ADHF patients (15 intervention arm, 12 attention control; ages 60-98 years; 56% African American; 59% women; 41% with preserved left ventricular rejection fraction). The study authors found that at baseline, the participants had marked impairments in physical function, multiple comorbidities, and frailty. Adherence to intervention (93%) and study retention (89%) were both excellent. At 3 months, an intervention effect size was measured for the SPPB score of +1.1 U (7.4 ± 0.5 U vs. 6.3 ± 0.5 U)—for perspective on this magnitude of effect size, a clinically meaningful change in SPPB score is +0.6 U. And at 6 months, an effect size was observed for an all-cause rehospitalization rate of -0.48 (1.16 ± 0.35 vs. 1.64 ± 0.39). The change in SPPB score was inversely correlated with the change in 6-month all-cause rehospitalizations (-0.60) (p < 0.01), explaining 91% of change.
Conclusions:
The authors concluded that the intervention is feasible and merits further study.
Perspective:
The findings of this pilot study are important because it suggests that tailored cardiac rehabilitation is very effective. Larger studies are needed to confirm these findings.
Keywords: Cardiac Rehabilitation, Cardiac Surgical Procedures, Cardiology Interventions, Comorbidity, Exercise Therapy, Geriatrics, Heart Failure, Patient Discharge, Secondary Prevention
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