Source / Disclosures
Kitzman D, et al. Joint American College of Cardiology / Journal of the American Medical Association Late-Breaking Clinical Trials. Presented at: Scientific Session of the American College of Cardiology; May 15-17, 2021 (virtual meeting).
Kitzman reports that he advises AbbVie, AstraZeneca, Bayer, Boehringer Ingelheim, Corvia, Keyto, Merck, Novartis and St. Luke’s Health Initiative and received donations from AstraZeneca, Bayer, Novartis and St. Luke’s Health Initiative. Please refer to the study for other authors’ relevant financial disclosures. Anker reports that he received grants and personal fees from several pharmaceutical and device companies. Coats reports that he has received personal fees from several pharmaceutical and device companies.
Elderly patients hospitalized for acute HF who participated in a 12-week early, personalized rehabilitation program had better results compared to those who received standard treatment, according to the results of the REHAB-HF trial.
For the essay, presented at the Scientific Session of the American College of Cardiology and published in The new English medical journal, the researchers enrolled 349 hospitalized patients with HF aged between 60 and 99 years (51% women; 53% with HF with preserved ejection fraction; 97% fragile or pre-rails). Patients were allocated to the intervention, which consisted of the usual care plus a program focused on strength, balance, mobility and endurance in which progression of intensity and types of exercises performed based on the level of performance, or to a control group of attention, which consisted of phone calls and the usual care alone.
Dalane W. Kitzman
“Our hypothesis was that in frail, elderly patients, hospitalized for Acute decompensated HF, an innovative, early, adapted, progressive rehabilitation intervention, from multiple domains, will improve physical function and reduce hospitalizations, ” Dalane W. Kitzman, MD, professor of cardiovascular medicine and geriatrics / gerontology at Wake Forest School of Medicine, said in a presentation.
In the intervention group, the patient’s retention rate was 82% and the adherence rate to the sessions was 78%, according to the researchers.
When the researchers adjusted the battery score for short physical performance and other baseline characteristics, the primary result of the mean least squares score on the battery for short physical performance at 3 months was 8.3 in the intervention group compared to 6.9 in the control group (mean between – group difference, 1.5; 95% CI, 0.9-2; P <0.001). Kitzman said during the presentation that the effect of the treatment was relatively consistent across the pre-specified subgroups.
At 3 months, compared to the control group, the intervention group had greater improvements in the 6-minute walking distance (P = 0.007), modified Fried Fragility Criteria (P = 0.028), scores from the Cardiomyopathy Questionnaire of Kansas City (P = 0.007)) and geriatric depression scare score (P = 0.013), said Kitzman during the presentation.
“At 6 months, 83% of the participants in the intervention reported regular exercise at home, which suggests a change in behavior, a prerequisite for long-term adherence,” said Kitzman during the presentation.
According to the researchers, in 6 months, the readmission rates for any cause were 1.18 in the intervention group and 1.28 in the control group (rate ratio = 0.93; 95% CI, 0.66- 1.19).
The researchers observed that there were 21 deaths in the intervention group and 16 in the control group, for rates of 0.13 and 0.1, respectively (rate ratio = 1.17; 95% CI, 0.61-2.27 ).
“At 6 months, 83% of the intervention participants reported regular exercise at home, which suggests behavioral change, a prerequisite for lasting behavioral change,” said Kitzman during the presentation.
Stefan D. Anker
Andrew J.S. Jackets
The results presented by Kitzman and colleagues provide a convincing argument for adopting exercise rehabilitation as a standard treatment, even for elderly and frail patients with acute heart failure ”. Stefan D. Anker, MD, professor at the Berlin-Brandenburg Center for Regenerative Therapies and the cardiology department at Charité University in Berlin, Germany, and Andrew J.S. Jackets, DM, professor of medicine at the University of Warwick, Coventry, UK, wrote in a related editorial in NEJM.