American College of Cardiology

American College of Cardiology

Source:

Kitzman D, et al. Joint American College of Cardiology/Journal of the American Medical Association Late-Breaking Clinical Trials. Presented at: American College of Cardiology Scientific Session; May 15-17, 2021 (virtual meeting).



Disclosures: Kitzman reports she consults for AbbVie, AstraZeneca, Bayer, Boehringer Ingelheim, Corvia, Keyto, Merck, Novartis and St. Luke’s Health Initiative and received grants from AstraZeneca, Bayer, Novartis and St. Luke’s Health Initiative. Please see the study for the other authors’ relevant financial disclosures. Anker reports he received grants and personal fees from various pharmaceutical and device companies. Coats reports he received personal fees from various pharmaceutical and device companies.

May 16, 2021
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REHAB-HF: Rehabilitation program improves physical function in older adults with HF

Source:

Kitzman D, et al. Joint American College of Cardiology/Journal of the American Medical Association Late-Breaking Clinical Trials. Presented at: American College of Cardiology Scientific Session; May 15-17, 2021 (virtual meeting).



Disclosures: Kitzman reports she consults for AbbVie, AstraZeneca, Bayer, Boehringer Ingelheim, Corvia, Keyto, Merck, Novartis and St. Luke’s Health Initiative and received grants from AstraZeneca, Bayer, Novartis and St. Luke’s Health Initiative. Please see the study for the other authors’ relevant financial disclosures. Anker reports he received grants and personal fees from various pharmaceutical and device companies. Coats reports he received personal fees from various pharmaceutical and device companies.

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Older adults hospitalized for acute HF who participated in an early, tailored 12-week rehabilitation program had better outcomes compared with those receiving standard care, according to results of the REHAB-HF trial.

For the trial, presented at the American College of Cardiology Scientific Session and published in The New England Journal of Medicine, the researchers enrolled 349 hospitalized patients with HF aged 60 to 99 years (51% women; 53% with HF with preserved ejection fraction; 97% frail or prefrail). The patients were assigned to the intervention, which consisted of the usual care plus a program focusing on strength, balance, mobility and endurance in which progression of intensity and types of exercises performed based on performance level, or to an attention control group, which consisted of phone calls and the usual care alone.

Man being assisted in lifting weights
Source: Adobe Stock
Dalane W. Kitzman

“Our hypothesis was that in frail, older patients, hospitalized for acute decompensated HF, an innovative, early transitional, tailored, progressive, multidomain, rehab intervention will improve physical function and reduce hospitalizations,” Dalane W. Kitzman, MD, professor of cardiovascular medicine and geriatrics/gerontology at Wake Forest School of Medicine, said in a presentation.

In the intervention group, the patient retention rate was 82% and the rate of adherence to the sessions was 78%, according to the researchers.

When researchers adjusted for baseline Short Physical Performance Battery score and other baseline characteristics, the primary outcome of the least-squares mean score on the Short Physical Performance Battery at 3 months was 8.3 in the intervention group compared with 6.9 in the control group (mean between-group difference, 1.5; 95% CI, 0.9-2; P < .001). Kitzman said during the presentation that the treatment effect was relatively consistent across prespecified subgroups.

At 3 months, compared with the control group, the intervention group had greater improvements in 6-minute walk distance (P = .007), modified Fried Frailty Criteria (P = .028), Kansas City Cardiomyopathy Questionnaire score (P = .007) and Geriatric Depression Scare score (P = .013), Kitzman said during the presentation.

“At 6 months, 83% of intervention participants reported regular home exercise, which suggests behavioral change, a prerequisite for long-term adherence,” Kitzman said during the presentation.  

According to the researchers, at 6 months, the rates of rehospitalization for any cause were 1.18 in the intervention group and 1.28 in the control group (rate ratio = 0.93; 95% CI, 0.66- 1.19).

 Researchers observed that there were 21 deaths in the intervention group and 16 in the control group, for rates of 0.13 and 0.1, respectively (rate ratio = 1.17; 95% CI, 0.61-2.27).

“At 6 months, 83% of intervention participants reported regular home exercise, which suggests behavioral change, a prerequisite for durable behavioral change,” Kitzman said during the presentation.

Stefan D. Anker
Andrew J.S. Coats

The results presented by Kitzman and colleagues provide a compelling argument for the adoption of exercise rehabilitation as standard care, even for elderly, frail patients with acute heart failure,” Stefan D. Anker, MD, professor in the Berlin-Brandenburg Center for Regenerative Therapies and the department of cardiology at Charité University in Berlin, Germany, and Andrew J.S. Coats, DM, professor of medicine at the University of Warwick, Coventry, United Kingdom, wrote in a related editorial in NEJM.

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