A Novel Rehabilitation Intervention for Older Patients With Acute Decompensated Heart Failure: The REHAB-HF Pilot Study

Abstract

Objectives: This study sought to assess a novel physical rehabilitation intervention in older patients hospitalized for acute decompensated heart failure (ADHF).

Background: After ADHF, older patients, who are frequently frail with multiple comorbidities, have prolonged and incomplete recovery of physical function and remain at high risk for poor outcomes.

Methods: The REHAB-HF (Rehabilitation Therapy in Older Acute Heart Failure Patients) pilot study was a 3-site, randomized, attention-controlled pilot study of a tailored, progressive, multidomain physical rehabilitation intervention beginning in the hospital and continuing for 12 weeks post-discharge in patients ≥60 years hospitalized with ADHF. The primary purpose was to assess the feasibility and reasonableness of the hypothesis that the novel rehabilitation intervention would improve physical function (Short Physical Performance Battery [SPPB]) over 3 months and reduce all-cause rehospitalizations over 6 months.

Results: The study enrolled 27 patients with ADHF (ages 60 to 98 years; 59% women; 56% African American; 41% with preserved ejection fraction [≥45%]). At baseline, participants had marked impairments in physical function, multiple comorbidities, and frailty. Study retention (89%) and intervention adherence (93%) were excellent. At 3 months, an intervention effect size was measured for the SPPB score of +1.1 U (7.4 ± 0.5 U vs. 6.3 ± 0.5 U), and at 6 months an effect size was observed for an all-cause rehospitalization rate of -0.48 (1.16 ± 0.35 vs. 1.64 ± 0.39). The change in SPPB score was strongly related to all-cause rehospitalizations, explaining 91% of change.

Conclusions: These findings support the feasibility and rationale for a recently launched, National Institutes of Health-funded trial to test the safety and efficacy of this novel multidomain physical rehabilitation intervention to improve physical function and reduce rehospitalizations in older, frail patients with ADHF with multiple comorbidities. (Rehabilitation and Exercise Training After Hospitalization [REHAB-HF]; NCT01508650; A Trial of Rehabilitation Therapy in Older Acute Heart Failure Patients [REHAB-HF]; NCT02196038).

Keywords: exercise; frailty; hospitalization; physical function; rehabilitation.

Figure 1

Comparison of the Short Physical Performance Battery (SPPB) and 6-Minute Walk distance (6MWD). At three months following hospital discharge the intervention effect size was +1.1 units for the SPPB score (7.4±0.5 vs 6.3±0.5 units) and +23 meters for the 6MWD (247±22 vs 224±22 meters). Comparisons made with analysis of covariance, with the 3-month value as the outcome and the baseline value as the covariate.

Figure 2

Comparison of 6-month all-cause rehospitalizations and rehospitalization days. The 6-month all-cause rehospitalization rate was 29% lower in the intervention group (1.16±0.35 vs 1.64±0.39), yielding an effect size −0.48 hospitalizations. The number of 6-month all-cause rehospitalization days were 47% lower per participant (6.0±2.5 vs 11.4±2.8), yielding an effect size of −5.4 days. Rehospitalization outcomes were tracked and analyzed for all 27 participants (Rehab n=15; Control n=12). Comparisons made with analysis of covariance with HF category (ejection fraction <45% or >45%) and baseline SPPB score as covariates.