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

dc.contributor.author

Mentz, Robert J

dc.contributor.author

Whellan, David J

dc.contributor.author

Reeves, Gordon R

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Pastva, Amy M

dc.contributor.author

Duncan, Pamela

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Upadhya, Bharathi

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Nelson, M Benjamin

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Chen, Haiying

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Reed, Shelby D

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Rosenberg, Paul B

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Bertoni, Alain G

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O'Connor, Christopher M

dc.contributor.author

Kitzman, Dalane W

dc.date.accessioned

2024-02-02T17:30:48Z

dc.date.available

2024-02-02T17:30:48Z

dc.date.issued

2021-10

dc.description.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).
dc.identifier

S2213-1779(21)00231-6

dc.identifier.issn

2213-1779

dc.identifier.issn

2213-1787

dc.identifier.uri

https://hdl.handle.net/10161/30118

dc.language

eng

dc.publisher

Elsevier BV

dc.relation.ispartof

JACC. Heart failure

dc.relation.isversionof

10.1016/j.jchf.2021.05.007

dc.rights.uri

https://creativecommons.org/licenses/by-nc/4.0

dc.subject

Humans

dc.subject

Ventricular Dysfunction, Left

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Stroke Volume

dc.subject

Prognosis

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Quality of Life

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Aged

dc.subject

Female

dc.subject

Heart Failure

dc.title

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

dc.type

Journal article

duke.contributor.orcid

Mentz, Robert J|0000-0002-3222-1719

duke.contributor.orcid

Pastva, Amy M|0000-0002-0891-745X

duke.contributor.orcid

Upadhya, Bharathi|0000-0001-7192-7995

duke.contributor.orcid

Reed, Shelby D|0000-0002-7654-4464

duke.contributor.orcid

Rosenberg, Paul B|0000-0002-5659-160X

pubs.begin-page

747

pubs.end-page

757

pubs.issue

10

pubs.organisational-group

Duke

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School of Medicine

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Basic Science Departments

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Clinical Science Departments

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Institutes and Centers

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Cell Biology

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Medicine

pubs.organisational-group

Orthopaedic Surgery

pubs.organisational-group

Pathology

pubs.organisational-group

Medicine, Cardiology

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Medicine, General Internal Medicine

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Medicine, Pulmonary, Allergy, and Critical Care Medicine

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Duke Cancer Institute

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Duke Clinical Research Institute

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Institutes and Provost's Academic Units

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Duke Molecular Physiology Institute

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Medicine, Clinical Pharmacology

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Initiatives

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Duke Science & Society

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Orthopaedic Surgery, Physical Therapy

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Population Health Sciences

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Duke - Margolis Center For Health Policy

pubs.publication-status

Published

pubs.volume

9

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