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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;385:203-16.
Editorial: Anker SD, Coats AJ. Exercise for Frail, Elderly Patients With Acute Heart Failure – A Strong Step Forward. N Engl J Med 2021;385:276-7.
Presented by Dr. Dalane W. Kitzman at the American College of Cardiology Virtual Annual Scientific Session (ACC 2021), May 16, 2021.
Clinical Topics: Cardiovascular Care Team, 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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