Gordon R Reeves1, David J Whellan1, Christopher M O'Connor2, Pamela Duncan3, Joel D Eggebeen3, Timothy M Morgan3, Leigh Ann Hewston4, Amy Pastva5, Mahesh J Patel6, Dalane W Kitzman7. 1. Department of Medicine, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania. 2. Department of Medicine, Duke University School of Medicine, Durham, North Carolina. 3. Department of Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina. 4. Department of Physical Therapy, Jefferson School of Health Professions, Philadelphia, Pennsylvania. 5. Department of Medicine, Duke University School of Medicine, Durham, North Carolina; Department of Orthopaedic Surgery, Doctor of Physical Therapy Division, Duke University School of Medicine, Durham, North Carolina. 6. Department of Medicine, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania; Department of Medicine, Duke University School of Medicine, Durham, North Carolina. 7. Department of Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina. Electronic address: dkitzman@wfubmc.edu.
Abstract
OBJECTIVES: This study sought to assess a novel physical rehabilitation intervention in older patients hospitalized for acute decompensated heart failure (ADHF). BACKGROUND: After ADHF, older patients, who are frequently frail with multiple comorbidities, have prolonged and incomplete recovery of physical function and remain at high risk for poor outcomes. METHODS: The REHAB-HF (Rehabilitation Therapy in Older Acute Heart Failure Patients) pilot study was a 3-site, randomized, attention-controlled pilot study of a tailored, progressive, multidomain physical rehabilitation intervention beginning in the hospital and continuing for 12 weeks post-discharge in patients ≥60 years hospitalized with ADHF. The primary purpose was to assess the feasibility and reasonableness of the hypothesis that the novel rehabilitation intervention would improve physical function (Short Physical Performance Battery [SPPB]) over 3 months and reduce all-cause rehospitalizations over 6 months. RESULTS: The study enrolled 27 patients with ADHF (ages 60 to 98 years; 59% women; 56% African American; 41% with preserved ejection fraction [≥45%]). At baseline, participants had marked impairments in physical function, multiple comorbidities, and frailty. Study retention (89%) and intervention adherence (93%) were excellent. At 3 months, an intervention effect size was measured for the SPPB score of +1.1 U (7.4 ± 0.5 U vs. 6.3 ± 0.5 U), and at 6 months an effect size was observed for an all-cause rehospitalization rate of -0.48 (1.16 ± 0.35 vs. 1.64 ± 0.39). The change in SPPB score was strongly related to all-cause rehospitalizations, explaining 91% of change. CONCLUSIONS: These findings support the feasibility and rationale for a recently launched, National Institutes of Health-funded trial to test the safety and efficacy of this novel multidomain physical rehabilitation intervention to improve physical function and reduce rehospitalizations in older, frail patients with ADHF with multiple comorbidities. (Rehabilitation and Exercise Training After Hospitalization [REHAB-HF]; NCT01508650; A Trial of Rehabilitation Therapy in Older Acute Heart Failure Patients [REHAB-HF]; NCT02196038).
RCT Entities:
OBJECTIVES: This study sought to assess a novel physical rehabilitation intervention in older patients hospitalized for acute decompensated heart failure (ADHF). BACKGROUND: After ADHF, older patients, who are frequently frail with multiple comorbidities, have prolonged and incomplete recovery of physical function and remain at high risk for poor outcomes. METHODS: The REHAB-HF (Rehabilitation Therapy in Older Acute Heart FailurePatients) pilot study was a 3-site, randomized, attention-controlled pilot study of a tailored, progressive, multidomain physical rehabilitation intervention beginning in the hospital and continuing for 12 weeks post-discharge in patients ≥60 years hospitalized with ADHF. The primary purpose was to assess the feasibility and reasonableness of the hypothesis that the novel rehabilitation intervention would improve physical function (Short Physical Performance Battery [SPPB]) over 3 months and reduce all-cause rehospitalizations over 6 months. RESULTS: The study enrolled 27 patients with ADHF (ages 60 to 98 years; 59% women; 56% African American; 41% with preserved ejection fraction [≥45%]). At baseline, participants had marked impairments in physical function, multiple comorbidities, and frailty. Study retention (89%) and intervention adherence (93%) were excellent. At 3 months, an intervention effect size was measured for the SPPB score of +1.1 U (7.4 ± 0.5 U vs. 6.3 ± 0.5 U), and at 6 months an effect size was observed for an all-cause rehospitalization rate of -0.48 (1.16 ± 0.35 vs. 1.64 ± 0.39). The change in SPPB score was strongly related to all-cause rehospitalizations, explaining 91% of change. CONCLUSIONS: These findings support the feasibility and rationale for a recently launched, National Institutes of Health-funded trial to test the safety and efficacy of this novel multidomain physical rehabilitation intervention to improve physical function and reduce rehospitalizations in older, frail patients with ADHF with multiple comorbidities. (Rehabilitation and Exercise Training After Hospitalization [REHAB-HF]; NCT01508650; A Trial of Rehabilitation Therapy in Older Acute Heart FailurePatients [REHAB-HF]; NCT02196038).
Authors: Miles D Witham; Roberta L Fulton; Carol A Greig; Derek W Johnston; Chim C Lang; Marjon van der Pol; Dwayne Boyers; Allan D Struthers; Marion E T McMurdo Journal: Circ Heart Fail Date: 2012-01-23 Impact factor: 8.790
Authors: Donald Lloyd-Jones; Robert J Adams; Todd M Brown; Mercedes Carnethon; Shifan Dai; Giovanni De Simone; T Bruce Ferguson; Earl Ford; Karen Furie; Cathleen Gillespie; Alan Go; Kurt Greenlund; Nancy Haase; Susan Hailpern; P Michael Ho; Virginia Howard; Brett Kissela; Steven Kittner; Daniel Lackland; Lynda Lisabeth; Ariane Marelli; Mary M McDermott; James Meigs; Dariush Mozaffarian; Michael Mussolino; Graham Nichol; Véronique L Roger; Wayne Rosamond; Ralph Sacco; Paul Sorlie; Randall Stafford; Thomas Thom; Sylvia Wasserthiel-Smoller; Nathan D Wong; Judith Wylie-Rosett Journal: Circulation Date: 2010-02-23 Impact factor: 29.690
Authors: Julie K Tilson; Samuel S Wu; Steven Y Cen; Qiushi Feng; Dorian R Rose; Andrea L Behrman; Stanley P Azen; Pamela W Duncan Journal: Stroke Date: 2012-01-12 Impact factor: 7.914
Authors: Gordon R Reeves; David J Whellan; Mahesh J Patel; Christopher M O'Connor; Pamela Duncan; Joel D Eggebeen; Timothy M Morgan; Leigh A Hewston; Amy M Pastva; Dalane W Kitzman Journal: Am J Cardiol Date: 2016-04-06 Impact factor: 2.778
Authors: L P Fried; C M Tangen; J Walston; A B Newman; C Hirsch; J Gottdiener; T Seeman; R Tracy; W J Kop; G Burke; M A McBurnie Journal: J Gerontol A Biol Sci Med Sci Date: 2001-03 Impact factor: 6.053
Authors: Richard K Cheng; Margueritte Cox; Megan L Neely; Paul A Heidenreich; Deepak L Bhatt; Zubin J Eapen; Adrian F Hernandez; Javed Butler; Clyde W Yancy; Gregg C Fonarow Journal: Am Heart J Date: 2014-07-22 Impact factor: 4.749
Authors: Christopher M O'Connor; David J Whellan; Kerry L Lee; Steven J Keteyian; Lawton S Cooper; Stephen J Ellis; Eric S Leifer; William E Kraus; Dalane W Kitzman; James A Blumenthal; David S Rendall; Nancy Houston Miller; Jerome L Fleg; Kevin A Schulman; Robert S McKelvie; Faiez Zannad; Ileana L Piña Journal: JAMA Date: 2009-04-08 Impact factor: 56.272
Authors: Ann Christine Bodilsen; Mette Merete Pedersen; Janne Petersen; Nina Beyer; Ove Andersen; Louise Lawson Smith; Henrik Kehlet; Thomas Bandholm Journal: Am J Phys Med Rehabil Date: 2013-09 Impact factor: 2.159
Authors: Daniel E Forman; Jerome L Fleg; Dalane W Kitzman; Clinton A Brawner; Ann M Swank; Robert S McKelvie; Robert M Clare; Stephen J Ellis; Mark E Dunlap; Vera Bittner Journal: J Am Coll Cardiol Date: 2012-11-21 Impact factor: 24.094
Authors: Whitney E Hornsby; Mohamed-Ali Sareini; Jessica R Golbus; Cristen J Willer; Jennifer L McNamara; Matthew C Konerman; Scott L Hummel Journal: J Card Fail Date: 2018-09-13 Impact factor: 5.712
Authors: Haider J Warraich; Dalane W Kitzman; David J Whellan; Pamela W Duncan; Robert J Mentz; Amy M Pastva; M Benjamin Nelson; Bharathi Upadhya; Gordon R Reeves Journal: Circ Heart Fail Date: 2018-11 Impact factor: 8.790
Authors: Ambarish Pandey; Dalane Kitzman; David J Whellan; Pamela W Duncan; Robert J Mentz; Amy M Pastva; M Benjamin Nelson; Bharathi Upadhya; Haiying Chen; Gordon R Reeves Journal: JACC Heart Fail Date: 2019-12 Impact factor: 12.035
Authors: Mathew S Maurer; Evelyn Horn; Alex Reyentovich; Victoria Vaughan Dickson; Sean Pinney; Deena Goldwater; Nathan E Goldstein; Omar Jimenez; Sergio Teruya; Jeff Goldsmith; Stephen Helmke; Melana Yuzefpolskaya; Gordon R Reeves Journal: J Am Geriatr Soc Date: 2017-09-21 Impact factor: 5.562
Authors: Yogesh N V Reddy; Masaru Obokata; Aaron D Jones; Gregory D Lewis; Sanjiv J Shah; Omar F Abouezzedine; Marat Fudim; Brooke Alhanti; Lynne W Stevenson; Margaret M Redfield; Barry A Borlaug Journal: J Card Fail Date: 2020-08-19 Impact factor: 5.712
Authors: Amy M Pastva; Pamela W Duncan; Gordon R Reeves; M Benjamin Nelson; David J Whellan; Christopher M O'Connor; Joel D Eggebeen; Leigh Ann Hewston; Karen M Taylor; Robert J Mentz; Paul B Rosenberg; Dalane W Kitzman Journal: Contemp Clin Trials Date: 2017-10-25 Impact factor: 2.226