Older, frail patients who have been hospitalized for acute heart failure find greater functional and quality of life benefits from early, transitional, tailored, progressive rehabilitation when compared with usual care, an inclusive new trial has found.
These patients typically have high rates of physical frailty, poor quality of life, delayed recovery, and frequent rehospitalizations. Physical dysfunction problems are often overlooked in their care management, and they also are rarely included in cardiac rehabilitation studies, according to the researchers.
With an aim to address these issues, they enrolled 349 heart failure patients with markedly impaired physical function in a multicenter, randomized, controlled trial. Fully 97% were frail or prefrail, with a mean number of five comorbidities. Half were assigned to an intervention group and half to a control group.
Rehabilitation included four physical-function domains: strength, balance, mobility and endurance, and it was initiated either during or just after hospitalization for heart failure. The trial lasted for 36 outpatient sessions. Participants were assessed at three months using the Short Physical Performance Battery, and the six-month rates of rehospitalization were recorded.
The intervention group had significantly greater improvement in physical function, the researchers found. An analysis of six-minute walking distance, frailty status, quality of life and depression suggested additional clinical benefits, wrote first author Dalane W. Kitzman, M.D., of Wake Forest Baptist Health, and colleagues.
There was a high incidence of rehospitalization for any cause or heart failure, and of death in both groups, however.
The problems faced by older patients with heart failure “probably contribute to delayed, incomplete recovery and high rates of rehospitalization, death, and long-term loss of independence after hospital discharge,” the authors wrote. The findings suggest that management guidelines for these patients should address physical dysfunction, they concluded.
In an accompanying editorial, experts praised the trial’s inclusion of severely compromised participants and the intervention.
“We congratulate the authors for having developed a program that is pragmatic, widely applicable, and able to be duplicated relatively easily in practice,” wrote Stefan D. Anker, M.D., Ph.D., of Charité University, Berlin, and Andrew J.S. Coats, D.M., of the University of Warwick, Coventry, U.K.
“The results presented by Kitzman and colleagues provide a compelling argument for the adoption of exercise rehabilitation as standard care, even for elderly, frail patients with acute heart failure,” they concluded.
Results were published in the New England Journal of Medicine.