title: A Novel Rehabilitation Intervention for Older Patients With Acute Decompensated Heart Failure: The REHAB-HF Pilot Study.
abstract: This study sought to assess a novel physical rehabilitation intervention in older patients hospitalized for acute decompensated heart failure (ADHF).
  
  
  
  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.
  
  
  
  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.
  
  
  
  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.
  
  
  
  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).
authors.affiliation: Department of Medicine, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania.
authors.forename: Gordon R
authors.initials: GR
authors.lastname: Reeves
authors.affiliation: Department of Medicine, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania.
authors.forename: David J
authors.initials: DJ
authors.lastname: Whellan
authors.affiliation: Department of Medicine, Duke University School of Medicine, Durham, North Carolina.
authors.forename: Christopher M
authors.initials: CM
authors.lastname: O'Connor
authors.affiliation: Department of Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina.
authors.forename: Pamela
authors.initials: P
authors.lastname: Duncan
authors.affiliation: Department of Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina.
authors.forename: Joel D
authors.initials: JD
authors.lastname: Eggebeen
authors.affiliation: Department of Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina.
authors.forename: Timothy M
authors.initials: TM
authors.lastname: Morgan
authors.affiliation: Department of Physical Therapy, Jefferson School of Health Professions, Philadelphia, Pennsylvania.
authors.forename: Leigh Ann
authors.initials: LA
authors.lastname: Hewston
authors.affiliation: 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.
authors.forename: Amy
authors.initials: A
authors.lastname: Pastva
authors.affiliation: Department of Medicine, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania; Department of Medicine, Duke University School of Medicine, Durham, North Carolina.
authors.forename: Mahesh J
authors.initials: MJ
authors.lastname: Patel
authors.affiliation: Department of Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina. Electronic address: dkitzman@wfubmc.edu.
authors.forename: Dalane W
authors.initials: DW
authors.lastname: Kitzman
mesh_terms: D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D003266:Continuity of Patient Care; D005081:Exercise Therapy / Q000379:methods*; D017079:Exercise Tolerance / Q000502:physiology*; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000175:diagnosis / Q000534:rehabilitation*; D006760:Hospitalization; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010101:Oxygen Consumption / Q000502:physiology; D010351:Patient Discharge; D010865:Pilot Projects; D018570:Risk Assessment; D012720:Severity of Illness Index; D013318:Stroke Volume / Q000502:physiology*; D016896:Treatment Outcome
keywords: exercise; frailty; hospitalization; physical function; rehabilitation