REHAB-HF: Physical rehabilitation feasible in older adults with acute decompensated HF
Physical rehabilitation intervention was found to be feasible in older adults with acute decompensated HF, according to findings from REHAB-HF published in JACC: Heart Failure.
“Acute decompensated HF is the leading cause of hospitalization in older adults and is associated with high rates of morbidity, mortality and health care expenditures,” Gordon R. Reeves, MD, interim director of VAD services and assistant professor at Jefferson Health, Philadelphia, and colleagues wrote. “Improving outcomes after [acute decompensated] HF hospitalization is a national health care priority. However, even with optimal adherence to HF management guidelines, outcomes after hospitalization remain poor and > 50% of patients experience readmission or death within 6 months.”
Reeves and colleagues implemented a physical rehabilitation intervention beginning in the hospital and continuing for 12 weeks after discharge in participants with acute decompensated HF (n = 27; aged 60 to 98 years; 59% women; 56% black; 41% with ejection fraction 45%).
The intervention program focused on balance, strength, mobility and endurance through exercise adapted for older patients with various function levels. Exercise was conducted in a guided environment, but participants were also given home exercises to complete.
The researchers assessed for improved physical function over 3 months, evaluated through short physical performance battery (SPPB), and all-cause rehospitalization over 6 months vs. an attention-controlled group. The main outcome was safety and feasibility to guide the design of a larger trial.
Study retention occurred in 89% of participants and intervention adherence occurred in 93% of participants.
For SPPB, the intervention effect size at 3 months was +1.1 U (7.4 U vs. 6.3 U), and for all-cause rehospitalization, the effect size at 6 months was –0.48 hospitalizations (1.16 vs. 1.64). All-cause rehospitalization accounted for 91% of the change in SPPB score, according to the researchers.
“These findings support the reasonableness of our overall study hypothesis that a novel, tailored, progressive, multidomain physical rehabilitation intervention is feasible in older patients with [acute decompensated] HF who have high rates of frailty and comorbidities and has the potential to improve physical function and reduce rehospitalization rates,” the researchers wrote. “The results of this pilot study informed the design of a subsequent multicenter clinical trial that was funded by the NIH and is designed to definitively test this hypothesis. The recently launched trial (NCT02196038) will enroll 360 patients, a sample size supported by the present data.” – by Cassie Homer
Disclosure: Reeves reports receiving a research grant from Thoratec (now St. Jude Medical). The other researchers report no relevant financial disclosures.