Older adults with heart failure benefit from rehabilitation programme

In the REHAB-HF trial, older patients who experienced acute decompensated heart failure (HF) and participated in a physical rehabilitation programme achieved improvements in physical function, Kansas City Cardiomyopathy Questionnaire (KCCQ), and depression scores [1,2].

Older patients with acute decompensated HF are often physically frail, have a poor quality of life, and are frequently rehospitalised. Current guidelines fail to address physical functioning in older patients with acute decompensated HF. Accordingly, the REHAB-HF trial (NCT02196038) aimed to investigate the effects of a tailored, progressive rehabilitation programme in older adults who had been hospitalised for acute decompensated HF. Dr Dalane Kitzman (Wake Forest School of Medicine, NC, USA) presented the results.

The trial randomised 349 patients to either participate in the rehabilitation programme (n=175) or to receive usual care (n=174). The rehabilitation programme consisted of 36 sessions delivered over 12 weeks and encompassed endurance, mobility, strength, and balance training. The primary outcome was a change in short physical performance battery (SPPB) score, which was assessed at baseline and upon programme completion. The SPPB tests standing balance, walking, and strength.

At 3 months, the least-squares mean score on the SPPB score was 8.3 in the rehabilitation group and 6.9 in the usual care group. This yielded a mean between-group difference of 1.5 (95% CI 0.9–2.0; P<0.001).

The secondary outcome was all-cause rehospitalisation within 6 months. The rehospitalisation rate at 6 months was not significantly different between the 2 groups, with 1.18 in the rehabilitation group and 1.28 in the usual care group (rate ratio 0.93; 95% CI 0.66–1.19).

Authors of a New England Journal of Medicine Editorial editors declared that “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” [3].

1. 
   
   1. Kitzman DW. A Novel Physical Rehabilitation Intervention for Older Patients with Acute Decompensated Heart Failure: The REHAB-HF Trial. ACC Scientific Session, 15–17 May 2021.
   2. Kitzman DW, et al. N Engl J Med 2021;May 16. DOI: 10.1056/NEJMoa2026141.
   3. Anker SD, Coats AJS. N Engl J Med Editorial 2021;May 16. DOI: 10.1056/NEJMe2106140.

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Posted on 9 July 202129 July 2021