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Randomized Controlled Trial
. 2022 Jan;135(1):82-90.
doi: 10.1016/j.amjmed.2021.08.001. Epub 2021 Sep 10.

Physical Rehabilitation in Older Patients Hospitalized with Acute Heart Failure and Diabetes: Insights from REHAB-HF

Evan M Murray  1 , David J Whellan  2 , Haiying Chen  3 , Alain G Bertoni  4 , Pamela Duncan  5 , Amy M Pastva  6 , Dalane W Kitzman  7 , Robert J Mentz  8
Affiliations
Randomized Controlled Trial

Physical Rehabilitation in Older Patients Hospitalized with Acute Heart Failure and Diabetes: Insights from REHAB-HF

Evan M Murray et al. Am J Med. 2022 Jan.

Abstract

Background: Prior studies showed an attenuated response to exercise training among patients with heart failure and type 2 diabetes mellitus. We explored the interaction between diabetes status and a novel, transitional, tailored, progressive rehabilitation intervention that improved physical function compared with usual care in the Rehabilitation Therapy in Older Acute Heart Failure Patients (REHAB-HF) trial.

Methods: The effect of the intervention on 3-month Short Physical Performance Battery (SPPB) (primary endpoint), 6-minute walk distance (6MWD), modified Fried frailty criteria, and quality-of-life scores (Kansas City Cardiomyopathy Questionnaire [KCCQ] and EuroQoL Visual Analogue Scale [VAS]) was compared between participants with and without diabetes. Differences in 6-month clinical outcomes were also explored.

Results: Of the 349 participants enrolled in REHAB-HF, 186 (53%) had diabetes. The prevalence of diabetes was higher in the intervention group (59% vs 48%). Participants with diabetes had worse baseline physical function by the SPPB and 6MWD, but similar frailty and quality-of-life scores. There was a consistent improvement with the intervention for 3-month SPPB, 6MWD, and VAS regardless of diabetes status (all interaction P value > .6), but participants with diabetes had significantly less improvement for frailty (P = .021) and a trend toward lower improvement in KCCQ (P = .11). There was no significant interaction by diabetes status for 6-month clinical event outcomes (all interaction P value > .3).

Conclusions: Participants with diabetes had worse baseline physical function but showed similar clinically meaningful improvements from the intervention. There was less benefit for frailty with the intervention in participants with diabetes.

Keywords: Acute decompensated heart failure; Diabetes mellitus; Heart failure; Physical rehabilitation.

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Figures

Figure 1.
Figure 1.. Physical Rehabilitation in Older Patients with Acute Decompensated Heart Failure with and without Diabetes Mellitus (DM)
Central Illustration. Effect of the novel REHAB-HF intervention in patients with acute decompensated heart failure on outcomes at 3 months in participants with Diabetes Mellitus (shown in red) and without (shown in blue). Abbreviations: SPPB indicates Short Physical Performance Battery; DM. Diabetes Mellitus; QOL, Quality of Life; KCCQ; Kansas City Cardiomyopathy Questionnaire
See this image and copyright information in PMC

References

    1. Dunlay SM, Givertz MM, Aguilar D, et al. Type 2 Diabetes Mellitus and Heart Failure: A Scientific Statement From the American Heart Association and the Heart Failure Society of America: This statement does not represent an update of the 2017 ACC/AHA/HFSA heart failure guideline update. Circulation. 2019;140(7):e294–e324. doi:10.1161/CIR.0000000000000691 - DOI - PubMed
    1. Heidenreich PA, Albert NM, Allen LA, et al. Forecasting the Impact of Heart Failure in the United States. Circ Hear Fail. 2013;6(3):606–619. doi:10.1161/HHF.0b013e318291329a - DOI - PMC - PubMed
    1. From AM, Leibson CL, Bursi F, et al. Diabetes in Heart Failure: Prevalence and Impact on Outcome in the Population. Am J Med. 2006;119(7):591–599. doi:10.1016/j.amjmed.2006.05.024 - DOI - PubMed
    1. Lawson CA, Jones PW, Teece L, et al. Association Between Type 2 Diabetes and All-Cause Hospitalization and Mortality in the UK General Heart Failure Population. JACC Hear Fail. 2018;6(1):18–26. doi:10.1016/j.jchf.2017.08.020 - DOI - PubMed
    1. Fotos NV, Giakoumidakis K, Kollia Z, et al. Health-related quality of life of patients with severe heart failure: A cross-sectional multicentre study. Scand J Caring Sci. 2013;27(3):686–694. doi:10.1111/j.1471-6712.2012.01078.x - DOI - PubMed

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