Author + information
- Received June 20, 2016
- Revision received December 23, 2016
- Accepted December 26, 2016
- Published online March 8, 2017.
- Gordon R. Reeves, MD, MPTa,
- David J. Whellan, MD, MHSa,
- Christopher M. O'Connor, MDb,
- Pamela Duncan, PT, PhDc,
- Joel D. Eggebeen, MSc,
- Timothy M. Morgan, PhDc,
- Leigh Ann Hewston, PT, MEdd,
- Amy Pastva, PT, PhDb,e,
- Mahesh J. Patel, MDa,b and
- Dalane W. Kitzman, MDc,∗ ()
- aDepartment of Medicine, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania
- bDepartment of Medicine, Duke University School of Medicine, Durham, North Carolina
- cDepartment of Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina
- dDepartment of Physical Therapy, Jefferson School of Health Professions, Philadelphia, Pennsylvania
- eDepartment of Orthopaedic Surgery, Doctor of Physical Therapy Division, Duke University School of Medicine, Durham, North Carolina
- ↵∗Address for correspondence:
Dr. Dalane W. Kitzman, Internal Medicine, Sections of Cardiology and Geriatrics, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, North Carolina 27157-1045.
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)
This study was supported by NIH Grants R01AG045551 and R01AG18915; Claude D. Pepper Older Americans Independence Center of Wake Forest School of Medicine Winston-Salem, NC; NIH Grant P30AG021332; Kermit Glenn Phillips II Endowed Chair in Cardiology; Dean's Faculty Achievement Award, Jefferson College of Health Professions, Philadelphia, PA; and Oristano Family Research Fund. Dr. Reeves has received a research grant from Thoratec (now St. Jude Medical). All other authors have reported they have no relationships relevant to the contents of this paper to disclose. John R, Teerlink, MD, served as Guest Editor for this article.
- Received June 20, 2016.
- Revision received December 23, 2016.
- Accepted December 26, 2016.
- 2017 American College of Cardiology Foundation