Cardiac rehabilitation programs for heart failure (HF) patients are usually focused on endurance training but these exercises may be too complicated for many patients, especially for older ones who are often too frail.
On July 15, 2021, the New England Journal of Medicine published the results of a randomized trial showing the effectiveness of a novel physical rehabilitation program for patients with advanced HF, which aimed to improve the patients' ability to exercise, after which they could focus on endurance.
The REHAB-HF study was a multicenter, randomized, controlled trial to evaluate a transitional, tailored, progressive rehabilitation intervention that included four physical-function domains (strength, balance, mobility, and endurance). The intervention was initiated during, or early after, hospitalization for heart failure and was continued after discharge for 36 outpatient sessions. The primary outcome was the score on the Short Physical Performance Battery (SPPB), with lower scores indicating more severe physical dysfunction) at 3 months.
A total of 349 patients underwent randomization; 175 were assigned to the rehabilitation intervention and 174 to usual care (control). At baseline, patients in each group had markedly impaired physical function, and 97% were frail or prefrail. It is noteworthy that patient retention in the intervention group was as high as 82%.
After 12 weeks, the least-squares mean (±SE) score on the Short Physical Performance Battery at 3 months was 8.3±0.2 in the intervention group and 6.9±0.2 in the control group (mean between-group difference, 1.5; 95% confidence interval [CI], 0.9 to 2.0; P<0.001). There were no differences between groups in readmission rates or mortality, but the study was not adequately powered to assess clinical outcomes.
Reference: https://www.nejm.org/doi/full/10.1056/NEJMoa2026141
