A multicentre, randomised, controlled trial to evaluate a transitional, tailored, progressive rehabilitation intervention for four physical function domains (strength, balance, mobility, and endurance) in old and frail patients hospitalised for HF. The study was funded by the National Institutes of Health and others; REHAB-HF ClinicalTrials.gov number, NCT02196038.
To assess the benefits of interventions on physical frailty and outcome in patients hospitalised for HF.
The intervention was initiated during, or early after, hospitalisation for HF and was continued after discharge for 36 outpatient sessions. The primary outcome was assessed by the score on the Short Physical Performance Battery (total scores range from 0 to 12, lower scores indicating more severe physical dysfunction) at three months. The secondary outcome was the 6-month rate of rehospitalisation for any cause.
The study group included 349 patients who underwent randomisation; 175 were assigned to the rehabilitation intervention and 174 to usual care (control). At baseline, all patients had markedly impaired physical function, and 97% were frail or prefrail; the mean number of coexisting conditions was five in each group. Patient retention in the intervention group was 82%, and adherence to the intervention sessions was 67. Over the course of six months, the incidence of rehospitalisation for any cause, rehospitalisation for heart failure, and death was high in both groups.
Old and frail patients hospitalised for acute decompensated heart failure, included in an early, transitional, tailored, progressive rehabilitation intervention programme, which consisted of multiple physical-function domains, resulted in greater improvement in physical function than usual care. The rehab programe had no influence on rehospitalisation and cv deaths.
Importance for clinical practice
The general cardiologist should encourage and recommend rehabilitation programme for frail and old patients after hospitalisation for HF. The rehab programe may have a positive influence on quality of life although it may not prolong it.