Understanding Patient and Care Partner Experiences With Rehabilitation After Hospitalization for Advanced Heart Failure: "I Was Thinking I'd Just Be Like I Was Before I Got This".

IMPORTANCE: Advanced Heart failure (HF) is a life-limiting condition that frequently necessitates hospitalization and subsequent post-acute rehabilitation for older adults. Despite high rates of post-acute care utilization, a notable gap exists in understanding the experiences of both patients and their care partners regarding rehabilitation. OBJECTIVE: The objective was to conduct semi-structured interviews with older adults hospitalized with advanced HF and their care partners to explore their prior experiences with HF rehabilitation, including perceived benefits, unmet needs, and opportunities for improvement. DESIGN: Between 2021 and 2023, a qualitative descriptive approach was used to conduct semi-structured interviews with patients hospitalized at an urban academic medical center with advanced HF (n = 12) and care partners (n = 11). Human-centered design principles and the Framework Method were used to guide study design and analyze semi-structured interviews. SETTING: Recruitment took place in the inpatient setting of a large academic medical center. Qualitative interviews were conducted at bedside, in a quiet area in the hospital, or via Zoom after discharge. Interview location was guided by participant preferences and whether the patient had previously participated in HF rehabilitation prior to their current admission or was initiating rehabilitation for the first time following their hospitalization. PARTICIPANTS: Patients were eligible to participate if they were community-dwelling (non-institutionalized), aged 65 years and older, had New York Heart Association (NYHA) Class III to IV symptoms, able to speak and read English, and had a history of receiving rehabilitation for their HF in the past (in any setting) or would be initiating it upon discharge. Patients were excluded if they were undergoing advanced therapy (organ transplant or left ventricular assist device placement), had severe cognitive impairment (diagnosis of Alzheimer's disease or related dementia, delirium, or altered mental status), or were enrolled in hospice during hospitalization or at hospital discharge. RESULTS: Three deductive domains were characterized: (1) patient and care partner rehabilitation experiences, (2) facilitators and barriers to participating in rehabilitation, and (3) recommendations for optimizing rehabilitation. In the recommendations domain, several inductive themes emerged, including: (1) enhance rehabilitation structure, (2) optimize communication between patients and therapists, (3) incorporate symptom management, and (4) provide structured activity recommendations and goals. RELEVANCE: Older adults with advanced HF are frequently hospitalized and require post-acute rehabilitation to address impairments in physical function. Our findings characterize patient and care partner experiences with post-acute rehabilitation and identify areas for improvement that may support the development of more effective post-acute rehabilitation interventions in advanced HF.

Duke Scholars

Author Amy Martha Pastva Orthopaedic Surgery, Physical Therapy