Rehabilitation Intervention in Older Patients With Acute Heart Failure With Preserved Versus Reduced Ejection Fraction.

Abstract

Objectives

This study assessed for treatment interactions by ejection fraction (EF) subgroup (≥45% [heart failure with preserved ejection fraction (HFpEF); vs <45% [heart failure with reduced ejection fraction (HFrEF)]).

Background

The REHAB-HF trial showed that an early multidomain rehabilitation intervention improved physical function, frailty, quality-of-life, and depression in older patients hospitalized with acute decompensated heart failure (ADHF).

Methods

Three-month outcomes were: Short Physical Performance Battery (SPPB), 6-min walk distance (6MWD), and Kansas City Cardiomyopathy Questionnaire (KCCQ). Six-month end points included all-cause rehospitalization and death and a global rank of death, all-cause rehospitalization, and SPPB. Prespecified significance level for interaction was P ≤ 0.1.

Results

Among 349 total participants, 185 (53%) had HFpEF and 164 (47%) had HFrEF. Compared with HFrEF, HFpEF participants were more often women (61% vs 43%) and had significantly worse baseline physical function, frailty, quality of life, and depression. Although interaction P values for 3-month outcomes were not significant, effect sizes were larger for HFpEF vs HFrEF: SPPB +1.9 (95% CI: 1.1-2.6) vs +1.1 (95% CI: 0.3-1.9); 6MWD +40 meters (95% CI: 9 meters-72 meters) vs +27 (95% CI: -6 meters to 59 meters); KCCQ +9 (2-16) vs +6 (-2 to 14). All-cause rehospitalization rate was nominally lower with intervention in HFpEF but not HFrEF [effect size 0.83 (95% CI: 0.64-1.09) vs 0.99 (95% CI: 0.74-1.33); interaction P = 0.40]. There were significantly greater treatment benefits in HFpEF vs HFrEF for all-cause death [interaction P = 0.08; intervention rate ratio 0.63 (95% CI: 0.25-1.61) vs 2.21 (95% CI: 0.78-6.25)], and the global rank end point (interaction P = 0.098) with benefit seen in HFpEF [probability index 0.59 (95% CI: 0.50-0.68)] but not HFrEF.

Conclusions

Among older patients hospitalized with ADHF, compared with HFrEF those with HFpEF had significantly worse impairments at baseline and may derive greater benefit from the intervention. (A Trial of Rehabilitation Therapy in Older Acute Heart Failure Patients [REHAB-HF]; NCT02196038).

Department

Description

Provenance

Citation

Published Version (Please cite this version)

10.1016/j.jchf.2021.05.007

Publication Info

Mentz, Robert J, David J Whellan, Gordon R Reeves, Amy M Pastva, Pamela Duncan, Bharathi Upadhya, M Benjamin Nelson, Haiying Chen, et al. (2021). Rehabilitation Intervention in Older Patients With Acute Heart Failure With Preserved Versus Reduced Ejection Fraction. JACC. Heart failure, 9(10). pp. 747–757. 10.1016/j.jchf.2021.05.007 Retrieved from https://hdl.handle.net/10161/30118.

This is constructed from limited available data and may be imprecise. To cite this article, please review & use the official citation provided by the journal.

Scholars@Duke

Pastva

Amy Martha Pastva

Professor in Orthopaedic Surgery

The major themes that embody Dr. Pastva's scholarly pursuits include:  a) mechanisms of physical reserve and resilience; b) rehabilitation strategies for improving the health and function of individuals living with chronic cardiovascular and pulmonary diseases and/or surviving critical illness; and c) pedagogical strategies that will optimize health professions curricula to address clinical practice expectations in aging and acute or critical illness. In addition to her faculty appointments, she is Director of Research in the Physical Therapy Division, a Senior Fellow in the Duke Center for the Study of Aging and Human Development, a Duke Pepper Older American Independence Center (OAIC) Scholar, and co-lead of the Center’s Health and Mobility Measures Core. She serves as an advisor in Duke Health's Cardiovascular and Pulmonary Physical Therapy Residency Program. She also serves on the American Physical Therapy Association’s ICU Rehabilitation Clinical Guideline Development Group, on the Research Committee of its Cardiovascular and Pulmonary Academy, and on the Editorial Board of the Physical Therapy & Rehabilitation Journal.

Upadhya

Bharathi Upadhya

Associate Professor of Medicine
Rosenberg

Paul Brian Rosenberg

Professor of Medicine
O'Connor

Christopher Michael O'Connor

Adjunct Professor in the Department of Medicine

Dr. O’Connor’s research interests include: acute heart failure; co-morbidities in heart failure; clinical trials; biomarkers; and novel pharmacological and non-pharmacological approaches for the treatment of heart failure.


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