Novel Rehabilitation Program Could Benefit ADHF-Related Physical Dysfunction

Dalane Kitzman, MD

A recent investigation presented at the American College of Cardiology (ACC) Annual Scientific Session highlighted the promise of a novel rehabilitation program among patients hospitalized for acute decompensated heart failure (ADHF).

In an interview with HCPLive®, lead investigator of the REHAB-HF trial Dalane Kitzman, MD, Wake Forest Baptist Health, discussed the motivation behind the study, noting it began “on the basis of a number of observations.”

“Older persons who are hospitalized for [ADHF] have persistently poor outcomes with very poor quality of life, frequent hospitalizations, high mortality” he said. He also noted that attempts to address these underlying issues have proven largely unsatisfactory. As such, he and his team believed physical dysfunction may be a potentially overlooked contributing factor.

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Following a pilot study that revealed a number of physical dysfunctions across various domains, Kitzman’s team conducted a multi-center, randomized, controlled trial that assessed the value of a transitional and tailored rehabilitation intervention that targeted patient strength, balance, mobility, and endurance.

Kitzman underscored the importance of the progressive nature of the program, noting the general ineffectiveness of traditional endurance training as well as the potential for it to increase risk for injuries and falls.

As such, the intervention was implemented in a randomized population following hospital admission for ADHF and continued for 36 sessions post-discharge.

The primary outcome sought by Kitzman and colleagues was Short Physical Performance Battery (SPPB) score—a validated measure used to assess physical function in frail older persons. Such measurements were taken at 3 months by blinded observers.

The main secondary outcome was 6-month all-cause rehospitalizations.

Overall, a total 349 patients were enrolled in the program, with ages ranged from 60-99 years. A majority (52%) were women, 49% were non-white, and 53% had preserved ejection fraction. Furthermore, patients averaged 5 co-morbidities and 97% were considered frail or pre-frail.

The team noted that the population demonstrated high intervention adherence (87%) as well as retention (91%). 

At 3-month follow-up, the intervention group (n = 175) had large increases in SPPB , resulting in average difference of +1.5 units compared to placebo (P < .001).

The group also demonstrated clinically meaningful improvements in 6-minute walk distance (+34; P = .003); Fried frailty criteria (-0.3; P = .03); Kansas City Cardiomyopathy Questionnaire overall score (+7 units; P = .007), and Geriatric Depression Survey-15 score (-0.7 units; P = .018).

There were significant improvements observed among patients with both preserved and reduced ejection fraction.

The team reported that—at 6-month follow-up—there were no significant differences between the groups in all-cause rehospitalizations (194 vs 213; P = .32), heart failure rehospitalizations (94 vs 110; P = 069), or deaths (21 vs 16; P = .64).

Kitzman noted that retention with the program continued to be strong even when patients continued their program at home. He also touted the overall patient satisfaction with the program.

“These patients, we believe, really understood that we were helping them,” he said. “In fact, some of our patient testimonials were really exuberant about how much a difference this made in their lives.”

The study, “A Novel Physical Rehabilitation Intervention for Older Patients with Acute Decompensated Heart Failure: The REHAB-HF Trial,” was presented at ACC 2021.