Patients with frail and acute decompensated heart failure benefit more from early rehab

The study REHAB-HF was published online January 4 in JAMA Cardiology.
Frailty is common among older patients with acute decompensated heart failure (ADHF) and is associated with worse quality of life (QOL) and a higher risk of clinical events. The analysis of the previously published multicenter randomized controlled trial "Rehabilitation in elderly patients with acute heart failure" (REHAB-HF) was showed that a 3-month early physical rehabilitation intervention improved physical function and quality of life (QoL) in comparison with usual care. The secondary analysis aimed to evaluate whether baseline frailty altered the benefits of the intervention or was associated with risk of adverse outcomes. Outcome was the Short Physical Performance Battery (SPPB) score at 3 months, all-cause hospitalization or mortality at 6 months.
This analysis of the REHAB-HF trial included 337 patients 60 years and older (181 (53.7%) were female) hospitalized for ADHF. Frailty assessed using modified Fried criteria.
A total of 192 (57.0%) were frail at baseline. A significant interaction was observed between baseline frailty status and the treatment arm for the primary trial end point of overall SPPB score, with a 2.6-fold larger improvement in SPPB with intervention among frail patients (2.1; 95% CI, 1.3-2.9) vs prefrail patients (0.8; 95% CI, −0.1 to 1.6; P for interaction = 0.03). Trends consistently favored a larger intervention effect size, with significant improvement among frail vs prefrail participants for 6-minute walk distance, QOL, and the geriatric depression score, but interactions did not achieve significance.

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