Frailty Status Moderates Outcomes of Rehabilitation in Acute Decompensated HF

A prespecified secondary analysis of results from a multicenter clinical trial found that patients with acute decompensated heart failure (ADHF) who were frailer at baseline benefited more greatly from an early, customized physical rehabilitation intervention than their less frail counterparts. These findings were published in JAMA Cardiology.

The Rehabilitation Therapy in Older Acute Heart Failure Patients (REHAB-HF; ClinicalTrials.gov Identifier: NCT02196038) trial recruited patients with ADHF aged 60 years or older between 2014 and 2019. The patients (N=349) received attention control or a tailored intervention that was initiated in the hospital setting and translated to the ambulatory setting after discharge. The active intervention comprised 3 weekly 60-minute rehabilitation sessions over 12 weeks that focused on strength, balance, mobility, and endurance. For this secondary analysis, outcomes of the rehabilitation intervention were evaluated on the basis of frailty status.

At baseline, the patients were categorized as not frail (3.5%), prefrail (41.5%), and frail (55.0%) according to the Fried criteria. The participants had a mean age of 72 (SD, 8) years, 53.7% were women, and 49.6% were Black.

At 3 months, the frail patients who received the rehabilitation intervention had significantly improved Short Physical Performance Battery (SPPB) score (effect size, 2.1; P <.001), a greater percent change in SPPB from baseline (effect size, 58; P <.001), and an improved 4-minute walk score (effect size, 0.8; P <.001), chair rise (effect size, 0.8; P <.001), overall Kansas City Cardiomyopathy Questionnaire (KCCQ) score (effect size, 11; P =.002), 6-minute walk distance (effect size, 49; P =.002), and balance score (effect size, 0.5; P =.002) compared with the control recipients.

Among the prefrail cohort, only chair rise was significantly improved among the intervention recipients compared with control patients (effect size, 0.5; P =.01).

For every 1-unit increase in the modified Fried score, the rehabilitation intervention decreased risk for all-cause rehospitalization at 3 months (risk ratio [RR], 0.65; 95% CI, 0.52-0.80; P <.001) and all-cause rehospitalization or mortality at 6 months (RR, 0.62; 95% CI, 0.50-0.76; P <.001).

This analysis had limited power to detect whether frailty status was a significant modifier of the trial outcomes.

“…baseline frailty status among older patients with ADHF modified the treatment effects of an early, transitional, tailored, progressive multidomain physical rehabilitation intervention, with more robust and significant improvements in physical function among frail vs prefrail patients,” the study authors wrote. “These findings suggest that the REHAB-HF intervention may be effective among frail older patients with HF who have a high burden of functional impairment and, thus, are most in need of such therapies.”

Disclosure: Multiple authors declared affiliations with industry. Please refer to the original article for a full list of disclosures.