Among critically ill patients with acute decompensated heart failure (ADHF), initiating an early cardiac rehabilitation (CR) program is feasible, safe and may improve physical function, according to a randomized clinical trial published July 30 in JAMA Network Open.

Linjing Wu, MS; Cuilian Dai, MD, FACC, et al., conducted a single-center, single-blind trial in China including 120 patients with severe ADHF (33% with NYHA class III and 68% class IV) who were hospitalized in the cardiac intensive care unit (CICU). Their mean age was 69 years and 33% were women. After a brief stabilization, the patients were randomized 1:1 to a progressive and personalized AHF-CR program administered during their CICU stay only or to usual care.

At randomization, all patients required mechanical or noninvasive ventilation to maintain normal arterial saturation. Pulmonary crackles were observed in 82% of control patients and 72% of intervention patients. Most patients received drug therapy: IV loop diuretics in 73% and 72% of the control and intervention patients, respectively, and intravenous (IV) vasoactive medications in 32% and 35%.

Results showed no significant improvement in the primary outcome of Short Physical Performance Battery (SPPB) scores at hospital discharge, with a median SPPB score difference between groups of 1.0 (95% CI, 0-2.0; p=0.16). For the other primary outcome of rehospitalization rates at six months, no between-group difference was observed (27% and 28%, respectively in the control and intervention groups).

Notably, an exploratory analysis found that Perme ICU Mobility (PERME) scores were higher in the intervention group at discharge, with a median between-group difference of 2.76 (95% CI, 0.77-4.74; adjusted p=0.04).

In an accompanying editorial comment, Bharathi Upadhya, MD, FACC, and R. Brandon Stacey, MS, MD, write that, although the study was small, "the results are compelling and showed that early CR in critically ill patients can be done safely." They opine that there is "a long way to go," however, because "early transitional rehabilitation for ADHF still faces great challenges and requires the cooperation of patients, nurses, and physicians."