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