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Physical Rehabilitation for Older Patients Hospitalized for Heart Failure.

Publication ,  Journal Article
Kitzman, DW; Whellan, DJ; Duncan, P; Pastva, AM; Mentz, RJ; Reeves, GR; Nelson, MB; Chen, H; Upadhya, B; Reed, SD; Espeland, MA; Hewston, L ...
Published in: N Engl J Med
July 15, 2021

BACKGROUND: Older patients who are hospitalized for acute decompensated heart failure have high rates of physical frailty, poor quality of life, delayed recovery, and frequent rehospitalizations. Interventions to address physical frailty in this population are not well established. METHODS: We conducted a multicenter, randomized, controlled trial to evaluate a transitional, tailored, progressive rehabilitation intervention that included four physical-function domains (strength, balance, mobility, and endurance). The intervention was initiated during, or early after, hospitalization for heart failure and was continued after discharge for 36 outpatient sessions. The primary outcome was the score on the Short Physical Performance Battery (total scores range from 0 to 12, with lower scores indicating more severe physical dysfunction) at 3 months. The secondary outcome was the 6-month rate of rehospitalization for any cause. RESULTS: A total of 349 patients underwent randomization; 175 were assigned to the rehabilitation intervention and 174 to usual care (control). At baseline, patients in each group had markedly impaired physical function, and 97% were frail or prefrail; the mean number of coexisting conditions was five in each group. Patient retention in the intervention group was 82%, and adherence to the intervention sessions was 67%. After adjustment for baseline Short Physical Performance Battery score and other baseline characteristics, the least-squares mean (±SE) score on the Short Physical Performance Battery at 3 months was 8.3±0.2 in the intervention group and 6.9±0.2 in the control group (mean between-group difference, 1.5; 95% confidence interval [CI], 0.9 to 2.0; P<0.001). At 6 months, the rates of rehospitalization 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 to 1.19). There were 21 deaths (15 from cardiovascular causes) in the intervention group and 16 deaths (8 from cardiovascular causes) in the control group. The rates of death from any cause were 0.13 and 0.10, respectively (rate ratio, 1.17; 95% CI, 0.61 to 2.27). CONCLUSIONS: In a diverse population of older patients who were hospitalized for acute decompensated heart failure, an early, transitional, tailored, progressive rehabilitation intervention that included multiple physical-function domains resulted in greater improvement in physical function than usual care. (Funded by the National Institutes of Health and others; REHAB-HF ClinicalTrials.gov number, NCT02196038.).

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Published In

N Engl J Med

DOI

EISSN

1533-4406

Publication Date

July 15, 2021

Volume

385

Issue

3

Start / End Page

203 / 216

Location

United States

Related Subject Headings

  • Recovery of Function
  • Physical Functional Performance
  • Patient Readmission
  • Middle Aged
  • Male
  • Humans
  • Hospitalization
  • Heart Failure
  • General & Internal Medicine
  • Frail Elderly
 

Citation

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Kitzman, D. W., Whellan, D. J., Duncan, P., Pastva, A. M., Mentz, R. J., Reeves, G. R., … O’Connor, C. M. (2021). Physical Rehabilitation for Older Patients Hospitalized for Heart Failure. N Engl J Med, 385(3), 203–216. https://doi.org/10.1056/NEJMoa2026141
Kitzman, Dalane W., David J. Whellan, Pamela Duncan, Amy M. Pastva, Robert J. Mentz, Gordon R. Reeves, M Benjamin Nelson, et al. “Physical Rehabilitation for Older Patients Hospitalized for Heart Failure.N Engl J Med 385, no. 3 (July 15, 2021): 203–16. https://doi.org/10.1056/NEJMoa2026141.
Kitzman DW, Whellan DJ, Duncan P, Pastva AM, Mentz RJ, Reeves GR, et al. Physical Rehabilitation for Older Patients Hospitalized for Heart Failure. N Engl J Med. 2021 Jul 15;385(3):203–16.
Kitzman, Dalane W., et al. “Physical Rehabilitation for Older Patients Hospitalized for Heart Failure.N Engl J Med, vol. 385, no. 3, July 2021, pp. 203–16. Pubmed, doi:10.1056/NEJMoa2026141.
Kitzman DW, Whellan DJ, Duncan P, Pastva AM, Mentz RJ, Reeves GR, Nelson MB, Chen H, Upadhya B, Reed SD, Espeland MA, Hewston L, O’Connor CM. Physical Rehabilitation for Older Patients Hospitalized for Heart Failure. N Engl J Med. 2021 Jul 15;385(3):203–216.

Published In

N Engl J Med

DOI

EISSN

1533-4406

Publication Date

July 15, 2021

Volume

385

Issue

3

Start / End Page

203 / 216

Location

United States

Related Subject Headings

  • Recovery of Function
  • Physical Functional Performance
  • Patient Readmission
  • Middle Aged
  • Male
  • Humans
  • Hospitalization
  • Heart Failure
  • General & Internal Medicine
  • Frail Elderly