Association of early acute‐phase rehabilitation initiation on outcomes among patients aged ≥90 years with acute heart failure

Ueno, Kensuke; Kaneko, Hidehiro; Kamiya, Kentaro; Okada, Akira; Itoh, Hidetaka; Konishi, Masaaki; Sugimoto, Tadafumi; Suzuki, Yuta; Matsuoka, Satoshi; Fujiu, Katsuhito; Michihata, Nobuaki; Jo, Taisuke; Takeda, Norifumi; Morita, Hiroyuki; Ako, Junya; Node, Koichi; Yasunaga, Hideo; Komuro, Issei

doi:10.1111/jgs.18283

Cited by 3 publications

(5 citation statements)

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“…Furthermore, among 25,000 patients admitted to the ICU for AHF, the implementation of acute CR led to decreased in-hospital mortality and reduced hospitalization duration [59] . Therefore, based on prior research findings and the outcomes of our study, we can infer that initiating rehabilitation early in patients with AHF is advantageous [47–49,57–58] .…”

Section: Big Data Analysis Reveals the Importance Of Physical Activitymentioning

confidence: 83%

“…2023 [46] People with unhealthy behavior separately; smoking habits (n = 365,259), physical inactivity (n = 759,272), skipping breakfast The research underscores the importance of exercise habits in this lifestyle change, indicating that cultivating regular exercise habits can play a crucial role in preventing CVD Acute-phase initiation of cardiac rehabilitation for short-term improvement in activities of daily living in patients hospitalized for acute heart failure [47] J Cardiovasc Dev Dis. 2022 [47] 306,826 patients hospitalized for HF Improvement in ADL Acute-phase CR initiation may result in short-term improvement in ADL in patients hospitalized for acute HF Association of early acutephase rehabilitation initiation on outcomes among patients aged ≥90 years with acute heart failure [48] J Am Geriatr Soc.…”

Section: Cr For Patients With Acute Hf (Ahf)mentioning

confidence: 99%

“…2023 [48] 41,896 patients hospitalized for HF those aged ≥90 years, who had a length of stay of ≥3 days, NYHA class of ≥II…”

Section: Cr For Patients With Acute Hf (Ahf)mentioning

confidence: 99%

“…Additionally, the study demonstrated the efficacy of acute CR in very elderly patients with AHF, including those admitted to the intensive care unit (ICU). Among 40,000 very elderly individuals, acute CR resulted in reduced in-hospital mortality, shorter length of stay, lower readmission rates, and improved ADLs [48] . Furthermore, among 25,000 patients admitted to the ICU for AHF, the implementation of acute CR led to decreased in-hospital mortality and reduced hospitalization duration [59] .…”

Section: Big Data Analysis Reveals the Importance Of Physical Activitymentioning

confidence: 99%

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Physical activity and cardiac rehabilitation for the primary and secondary prevention of heart failure

Komuro,

Ueno

et al. 2024

Cardiology Plus

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Heart failure (HF) is a mounting global health and financial concern. With the introduction of angiotensin receptor-neprilysin inhibitors and sodium-glucose cotransporter-2 inhibitors, outcomes for HF have improved dramatically in recent years, however, the increase in HF cases remains uncontrolled, and reliance on current medical treatment alone is no longer sufficient. Therefore, primary prevention through exercise habits and secondary prevention through cardiac rehabilitation (CR) are becoming increasingly important to reduce the number of HF cases. We have previously highlighted the benefits of adopting a healthy lifestyle in preventing cardiovascular disease (CVD), even in individuals with cancer. Our findings underscore the importance of incorporating regular exercise into lifestyle modification and highlight the critical role of exercise habits in primary prevention, especially in terms of CVD prevention. The importance of CR is emphasized in the many guidelines such as European, American, and Japanese guidelines. CR is given a Class I recommendation due to its association with improved prognosis for patients with HF. Furthermore, early initiation of CR is recommended, especially for older patients with HF, because CR has been reported to reduce the length of stay and prevent rehospitalization. In addition to the existing evidence, the Nationwide Population-Based Database in Japan has indicated the importance of CR in patients with acute HF and of enhancing gait speed in preventing HF. Although the importance of CR is recognized worldwide, actual utilization of CR by patients remains low. The challenge for the future is to raise awareness among attending physicians and patients about the importance of exercise habits and CR by actively promoting individualized rehabilitation.

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Section: Big Data Analysis Reveals the Importance Of Physical Activitymentioning

confidence: 83%

Section: Cr For Patients With Acute Hf (Ahf)mentioning

confidence: 99%

“…2023 [48] 41,896 patients hospitalized for HF those aged ≥90 years, who had a length of stay of ≥3 days, NYHA class of ≥II…”

Section: Cr For Patients With Acute Hf (Ahf)mentioning

confidence: 99%

Section: Big Data Analysis Reveals the Importance Of Physical Activitymentioning

confidence: 99%

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Physical activity and cardiac rehabilitation for the primary and secondary prevention of heart failure

Komuro,

Ueno

et al. 2024

Cardiology Plus

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“…A recent study reported that initiation of acute-phase CR improved short-term clinical outcomes including length of stay, 30-day readmission rate due to HF, and all-cause 30-day readmission in patients aged ≥90 years with AHF. 9 Additionally, initiation of outpatient CR after discharge reduced deaths and readmissions for HF without increasing medical costs. 10 However, in the FLAGSHIP study, outpatient CR after discharge of older adults with HF improved the short-term but not the long-term prognosis.…”

Section: Clinical Practice For Acute Heart Failure In Japanmentioning

confidence: 99%

Clinical Practice for Acute Heart Failure in Japan From the Nationwide Registry

Hirata,

Hirata

2024

Circ J

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with AHF can be attributed to the development of new medications, such as sodium-glucose cotransporter 2 (SGLT-2) inhibitors, and increased implementation of cardiac rehabilitation (CR).The guidelines for the treatment of acute and chronic HF recommend the use of angiotensin-converting enzyme (ACE) inhibitors, angiotensin II receptor blockers (ARBs), and mineralocorticoid receptor antagonists (MRAs) based on established evidence. 1,2 In the EARLIER trial, treatment with eplerenone, a selective MRA, in patients with AHF, reduced the risk of cardiovascular death or readmission due to HF within 6 months by 45%. 4 In posthoc analysis from this trial, eplerenone treatment improved clinical stability in the short-term following hospitalization for AHF, as indicated by decreased diuretic doses, B-type natriuretic peptide levels and reduced left ventricular volume. 5 From their JROAD-DPC study, Kanaoka et al Article p ????The opinions expressed in this article are not necessarily those of the editors or of the Japanese Circulation Society.

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The Benefits of Early Rehabilitation for Patients With Acute Heart Failure Requiring IV Inotropic Drugs

Ueno,

Kaneko,

Kamiya

et al. 2024

Critical Care Medicine

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Objectives: The benefits of early rehabilitation for patients with acute heart failure (HF) requiring IV inotropic drugs have yet to be determined. We investigated the association between early rehabilitation and short-term clinical outcomes in patients with acute HF requiring IV inotropic drugs. Design: Retrospective cohort study. Setting: This study used data including more than 90% of patients at a tertiary emergency hospital in Japan. Patients: This study included patients with acute HF who required IV inotropic drugs within 2 days of admission. Interventions: We compared patients who commenced rehabilitation within 2 days of admission (the early rehabilitation group) and those who did not (the control group). Measurements and Main Results: Propensity score matching was used to compare in-hospital mortality, 30-day all-cause and HF readmissions, length of stay, and Barthel Index (BI) at discharge between patients who received early rehabilitation and those who did not. Totally, 38,302 patients were eligible for inclusion; of these, 5,127 received early rehabilitation and 5,126 pairs were generated by propensity score matching. After propensity score matching, the patients who received early rehabilitation had a lower in-hospital mortality rate than those who did not (9.9% vs. 13.2%; p < 0.001). The relative risk (95% CI) of early rehabilitation for in-hospital mortality was 0.75 (0.67–0.83). Patients undergoing early rehabilitation exhibited a shorter mean length of stay (25.5 vs. 27.1; p < 0.001), lower 30-day all-cause (14.1% vs. 16.4%; p = 0.001) and HF (8.6% vs. 10.4%; p = 0.002) readmissions, and higher BI scores at discharge (68 vs. 67; p = 0.096). Consistent findings were observed across subgroups, including in patients 80 years old or older, those with a body mass index less than 18.5 kg/m2, and those with BI scores less than 60. Conclusions: The early prescription of rehabilitation was associated with favorable short-term outcomes even for patients with acute HF requiring IV inotropic drugs.

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Association of early acute‐phase rehabilitation initiation on outcomes among patients aged ≥90 years with acute heart failure

Cited by 3 publications

References 44 publications

Physical activity and cardiac rehabilitation for the primary and secondary prevention of heart failure

Physical activity and cardiac rehabilitation for the primary and secondary prevention of heart failure

Clinical Practice for Acute Heart Failure in Japan From the Nationwide Registry

The Benefits of Early Rehabilitation for Patients With Acute Heart Failure Requiring IV Inotropic Drugs

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