The 175 volunteers who received 36 outpatient sessions designed to improve strength, balance, mobility and endurance scored higher on a 13-point physical performance test after three months than 174 given usual care after their hospitalization for heart failure.
Their least-squares mean score was 1.5 points higher than the 6.9 score in the control group (P<0.001), according to the report in the New England Journal of Medicine.
"This group of patients has very severe physical dysfunction with high rates of frailty and a pattern of physical functional deficits that requires a novel approach," chief author Dr. Dalane Kitzman told Reuters Health by phone. "Our rehab heart-failure intervention improves physical function and quality of life" using a program tailored to each individual.
While the rates of rehospitalization for any cause, the rates of death from cardiovascular causes and the rates of death from any cause were lower in the intervention group, they were not significantly lower. Also, the intervention did not produce a significant decline in clinical events.
Thus, "as strong as these findings are, this may not be ready to insert into standard routine care," Dr. Kitzman said.
However, in a linked editorial Dr. Stefan Anker of Charite - Universitaetsmedizin Berlin, in Germany, and Dr. Andrew Coats of the University of Warwick, in the U.K., said the findings "provide a compelling argument for the adoption of exercise rehabilitation as standard care, even for elderly, frail patients with acute heart failure."
The results were also reported at a meeting of the American College of Cardiology.
Americans with acute decompensated heart failure rack up $39 billion in costs each year. Older people with the condition also tend to be frail. Heart failure only makes their physical problems worse.
"Many patients never recover baseline function, lose independence and have high risks of rehospitalization and death after discharge," said the team.
In an attempt to address that problem, Dr. Kitzman and his colleagues used the individually tailored exercise program of increasing intensity designed to get patients to walk longer after directly dealing with deficits in balance, strength and mobility. That was in addition to any inpatient or outpatient physical therapy and cardiac rehabilitation that traditionally makes up usual care.
"While it integrates principles of physical therapy and of traditional cardiac rehabilitation, it's dramatically different in many ways," he said. "The physical therapy is more intense, the sessions are of longer duration and it's sustained for a much longer period of time. This intervention truly is unique and novel, and is definitely not merely checking the box of physical therapy."
The intervention included 60-minute sessions three days per week for 12 weeks, along with walking at home with the goal of doing it for 30 minutes per day in conjunction with daily strengthening exercises.
The only thing patients in the control group were guaranteed was a phone call every two weeks and two in-person clinic visits after discharge. There were no specific exercise recommendations.
"At baseline, the patients were assessed as having severely impaired physical function, poor quality of life, and at least mild cognitive dysfunction," the researchers said. The volunteers had an average of five coexisting conditions.
In addition to a better score on the 13-point physical performance test (the Short Physical Performance Battery), "the results of the analyses of 6-minute walk distance, frailty status, quality of life, and depression also suggested clinical benefits of the intervention," the researchers write.
"The greater improvements in physical function relative to the control group were seen despite the receipt of routine physical or occupational therapy or traditional cardiac or pulmonary rehabilitation as part of usual care by 43% of the patients in the control group," the researchers report.
The intervention group tended to experience more chest pain, hypertension, dizziness, hyperglycemia and hypoglycemia. Falls and heart failure were more common in the control group.
SOURCES: https://bit.ly/3eInHub and https://bit.ly/33Yibhb The New England Journal of Medicine, online May 16, 2021.
By Gene Emery
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