Another Win for HF Patients: REHAB-HF Shows Benefit and Value for Focused Rehab Programs

Editor’s Note: This dispatch from ACC.21 was written by Devesh Rai, MD, a chief resident at Rochester General Hospital. Dr. Rai is also a correspondent with CardioNerds (@CardioNerds), a DocWire News partner. Follow Dr. Rai on Twitter (@DeveshRaiMD). WASHINGTONEarly focused, transitional, tailored, and progressive rehabilitation and exercise programs improves physical functioning and quality of life in older patients with acute decompensated heart failure (ADHF) when compared to usual care, according to the REHAB-HF1 study presented at the American College of Cardiology Annual Scientific Sessions (ACC.21). Heart failure (HF), particularly in the elderly, is associated with high rates of severe functional impairment and poor quality of life. Prior studies have evaluated the role of physical rehabilitation in chronic HF but have omitted patients with ADHF and the elderly with coexisting conditions. In REHAB-HF study, researchers investigated role of exercise therapy after hospitalization for ADHF in older patients (age>60 years).2 The intervention group comprised innovative specially designed physical function intervention specifically designed for older HF patients that commenced during, or early after hospitalization. Patients were followed after discharge; 3 days per week for 3 months in the specially designed rehab program. Thereafter patients were advised to continue unsupervised home-based exercise for further 3 months. The other attention arm received bi-weekly contact from the study personnel for 3 months following the index hospitalization and monthly telephone calls after that for 3 months.2 This study revealed significant improvement in physical functioning and quality of life at 3 months follow-up, and meaningful improvement in geriatric depression survey in the intervention arm. Patients had improved physical performance on short physical performance battery and were able to walk more on the 6-minute walk test. At 6 months follow-up, 83% of patients were still exercising on their own, suggesting they may have had a durable behavior change. While the rates of hospitalization and death did not differ substantially between groups, as noted by the accompanying NEJM editorial,3 this limitation isn’t unexpected, as previous studies have not shown a reduction in risk of death with exercise training in stable outpatients with HF. “Older patients hospitalized for ADHF have severe, broad deficits in physical function, and the novel REHAB-HF intervention produced large, significant improvements in physical function and quality of life but had no significant effects on clinical events,” Robert Mentz, MD, chief of heart failure at Duke University Medical Center, and co-author of REHAB-HF, said of the results. In the era of the personalized approach to patient centered care, REHAB-HF provides a strong rational for a focused and specialized rehabilitation plan for patients with ADHF with the goal of improving physical functioning and quality of life. References
  1. Kitzman DW, Whellan DJ, Duncan P, et al. Physical rehabilitation for older patients hospitalized for heart failure. N Engl J Med. 2021.
  2. Reeves GR, Whellan DJ, Duncan P, et al. Rehabilitation therapy in older acute heart failure patients (REHAB-HF) trial: Design and rationale. Am Heart J. 2017;185:130-39.
  3. Anker SD, Coats AJS. Exercise for frail, elderly patients with acute heart failure—A strong step forward. N Engl J Med. 2021.