Physical rehabilitation intervention improves physical function in older patients with ADHF

A Novel Physical Rehabilitation Intervention for Older Patients with Acute Decompensated Heart Failure: The REHAB-HF Trial

Presented at ACC.21 by Prof. Dalane Kitzman, MD (Winston-Salem, NC, USA)

Introduction and methods

Acute decompensated HF (ADHF) is associated with poor quality of life, frequent rehospitalization, physical frailty, high mortality and loss of independence. However, physical dysfunction is most often not addressed in ADHF clinical care pathways.

REHAB-HF was a multicenter, randomized, controlled trial to evaluate an individualized rehabilitation intervention that included four physical-function domains (strength, balance, mobility, and endurance). The intervention was designed for older, frail patients hospitalized with ADHF and was conducted 1-on-1 by a trained therapist. The intervention was started in the hospital or as soon as possible after discharge and transitioned to an outpatient facility 3 times per week for 12 weeks. After 12 weeks, the intervention transitioned to self-directed and home-based. A total of 349 patients (mean age 73 years, 51% women, 49% non-white, 97% were frail/pre-frail) were randomized 1:1 to the intervention group (n=175) or the usual care group (n=174). The primary outcome was the score on the Short Physical Performance Battery (SPPB, score ranges from 0 to 12, with lower scores indicating more severe physical dysfunction) at 3 months. The secondary outcome was the rate of rehospitalization for any cause at 6 months.

Main results

• SBBP scores at 3-month follow-up were significantly higher in the intervention group compared to the usual care group (mean between-group difference of +1.5, P<0.001). The difference of 1.5 units between groups is 3 times higher than the clinically meaningful change of 0.5 units.
• There were also significant improvements in the intervention group compared to the usual care group for 6-minute walk distance (mean between-group difference of +34 meters, P<0.007), Modified Fried Frailty Criteria (mean between-group difference of -0.6 criteria, P<0.028), KCCQ (mean between-group difference of +7.1 units, P<0.007), and Geriatric Depression Scale (mean between-group difference of -0.7 units, P<0.013).
• At 6 months, there were no significant differences in rates of rehospitalization for any cause between groups.
• After 6 months, 83% of patients from the intervention group reported regular home exercise.
• There were 3 SEA possibly related to the intervention, all self-limited.

Conclusion

This study showed that individualized physical rehabilitation intervention, compared to usual care, resulted in significant improvements in physical function, frailty, quality of life, and depression in older patients hospitalized for ADHF.

Discussion

The discussant Prof. Eileen Handberg, PhD said that this study is extremely important as the outcomes that were measured in this study are those that matter the most for patients with HF. This is a real-world intervention with significant impact. Prof. Handberg raised the point that a large number of patients were not eligible because they lived to far from the rehabilitation program. It would be useful if this intervention could be offered to more patients via telemedicine technology.

-Our coverage of ACC.21 is based on the information provided during the congress –

This study was simultaneously published in the N Engl J Med.