Rehabilitation Therapy in Older Acute Heart Failure Patients - REHAB-HF

Contribution To Literature:

The REHAB-HF trial showed that a tailored cardiac rehabilitation intervention program improved Short Physical Performance Battery (SPPB) score at 3 months among elderly frail patients admitted with ADHF, but did not result in a reduction in readmissions or mortality.

Description:

The goal of the trial was to assess the safety and efficacy of a tailored cardiac rehabilitation program compared with standard measures among elderly patients hospitalized with acute decompensated heart failure (ADHF).  

Study Design

Eligible patients were randomized in a 1:1 fashion to either a cardiac rehabilitation intervention (n = 175) or control (n = 174).

  • Total number of enrollees: 349
  • Duration of follow-up: 3 months
  • Mean patient age: 73 years
  • Percentage female: 52%

Cardiac rehabilitation was conducted on an outpatient basis, 3 times/week for 12 weeks, and transitioned to self-directed home-based exercise. It was tailored for an older, frail adult population.

Inclusion criteria:

  • Adequate clinical stability to allow participation in study assessments and intervention Independent with basic activities of daily living (ADLs) and ambulation prior to admission
  • Able to walk 4 meters at enrollment (assistive device allowed)

Exclusion criteria:

  • Acute myocardial infarction, left ventricular assist device, planned surgery
  • Planned discharge to skilled nursing facility
  • Life expectancy <1 year
  • Impairment from stroke, dementia, or other medical disorder that precluded participation
  • Severe chronic kidney disease (estimated glomerular filtration rate <20) or dialysis

Other salient features:

  • Mean body mass index: 33 kg/m2
  • Days hospitalized for index admission: 4.5 days
  • Frail or prefrail by modified Fried criteria: 97%

Principal Findings:

The primary outcome, change in SPPB (Short Physical Performance Battery) score units at 3 months, for intervention vs. control, was 8.3 vs. 6.9 (mean between-group difference, 1.5; p < 0.001) (adjusted for baseline score). Improvements were noted in all three domains (balance score, 4-meter walk score, chair rise score).

Secondary outcomes for intervention vs. control:

  • 6-minute walk distance: 293 vs. 260 (p = 0.007)
  • Gait speed: 0.8 vs. 0.68 (p < 0.05)
  • Kansas City Cardiomyopathy Questionnaire: 69 vs. 62 (p = 0.007)
  • All-cause rehospitalization at 6 months: 1.18 vs. 1.28/patient (p = 0.32)
  • All-cause rehospitalization or mortality at 6 months: 1.31 vs. 1.38/patient (p = 0.44)

Interpretation:

The results of this trial indicate that a tailored cardiac rehabilitation intervention program improved SPPB at 3 months among elderly frail patients admitted with ADHF, but did not result in a reduction in readmissions or mortality. Despite this, the functional improvements observed in this trial are likely clinically meaningful. Adherence to the intervention was high (82%); reproducibility in other settings, long-term adherence, and effect on outcomes are all unclear.

References:

Kitzman DW, Whellan DJ, Duncan P, et al. Physical Rehabilitation for Older Patients Hospitalized for Heart Failure. N Engl J Med 2021;May 16:[Epub ahead of print].

Editorial: Anker SD, Coats AJ. Exercise for Frail, Elderly Patients With Acute Heart Failure – A Strong Step Forward. N Engl J Med 2021;May 16:[Epub ahead of print].

Presented by Dr. Dalane W. Kitzman at the American College of Cardiology Virtual Annual Scientific Session (ACC 2021), May 16, 2021.

Clinical Topics: Diabetes and Cardiometabolic Disease, Geriatric Cardiology, Heart Failure and Cardiomyopathies, Prevention, Acute Heart Failure, Exercise

Keywords: ACC21, ACC Annual Scientific Session, Activities of Daily Living, Cardiac Rehabilitation, Cardiomyopathies, Exercise, Frail Elderly, Geriatrics, Heart Failure, Outpatients, Patient Readmission, Self-Help Devices, Walking


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