Rehabilitation Intervention in Older Patients With Acute Heart Failure With Preserved Versus Reduced Ejection Fraction.
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2021-10
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Abstract
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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).Type
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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.
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Scholars@Duke
Robert John Mentz
I am a cardiologist with a clinical and research interest in heart failure (going from Failure to Function), including advanced therapies such as cardiac transplantation and mechanical assist devices or “heart pumps."
I serve our group as Chief of the Heart Failure Section.
I became a heart failure cardiologist in order to help patients manage their chronic disease over many months and years. I consider myself strongly committed to compassionate patient care with a focus on quality of life and patient preference.
I am the Editor in Chief of the Journal of Cardiac Failure - The official journal of the Heart Failure Society of America.
My research interests are focused on treating co-morbid diseases in heart failure patients and improving outcomes across the cardiovascular spectrum through clinical trials and outcomes research. Below, you will find my specific research interests:
- Cardiometabolic disease
- Co-morbidity characterization (diabetes, sleep apnea, renal failure) in heart failure
- Phenotypic characterization and risk prognostication of patients with heart failure
- Role of surrogate and nonfatal endpoints in clinical heart failure trials
- Biomarkers in heart failure
- Novel pharmacological and non-pharmacological approaches to heart failure
- Improving site-based heart failure research
Amy Martha Pastva
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.
Bharathi Upadhya
Shelby Derene Reed
Shelby D. Reed, PhD, is Professor in the Departments of Population Health Sciences and Medicine at Duke University’s School of Medicine. She is the director of the Center for Informing Health Decisions and Therapeutic Area leader for Population Health Sciences at the Duke Clinical Research Institute (DCRI). She also is core faculty at the Duke-Margolis Center for Health Policy. Dr. Reed has over 20 years of experience leading multidisciplinary health outcomes research studies. Dr. Reed has extensive expertise in designing and conducting trial-based and model-based cost-effectiveness analyses of diagnostics, drugs and patient-centered interventions. In 2016, she co-founded the Preference Evaluation Research (PrefER) Group at the DCRI, and she currently serves as its director. She and the group are frequently sought to conduct stated-preference studies to inform regulatory decisions, health policy, care delivery, value assessment and clinical decision making with applied projects spanning a wide range of therapeutic areas. She served as President for ISPOR in 2017-2018, and she currently is Past-Chair of the Society’s Health Science Policy Council.
Areas of expertise: Health Economics, Health Measurement, Stated Preference Research, Health Policy, and Health Services Research
Paul Brian Rosenberg
Christopher Michael O'Connor
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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