Physical Rehabilitation in Older Patients Hospitalized with Acute Heart Failure and Diabetes: Insights from REHAB-HF

Murray, Evan; Whellan, David J.; Chen, Haiying; Bertoni, Alain G.; Duncan, Pamela W.; Pastva, Amy M.; Kitzman, Dalane W.; Mentz, Robert J.

doi:10.1016/j.amjmed.2021.08.001

Cited by 8 publications

(18 citation statements)

References 41 publications

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“…These findings suggest that the favorable effect of exercise-based CR on physical function was equally manifested in patients with CVD and T2DM, with or without SGLT2 inhibitor use. Our study is consistent with a previous study, which reported that exercise-based CR contributed to the recovery of physical function in HF patients, with or without T2DM [ 20 ]. Previous studies examining the effect of SGLT2 inhibitor use on exercise tolerance in nondiabetic patients with HF have shown that the prescription of SGLT2 inhibitors contributed to the improvement in exercise tolerance (peak VO 2 , 6 MWD) [ 21 , 22 ].…”

Section: Discussionsupporting

confidence: 93%

Association between SGLT2 Inhibitors and Cardiac Rehabilitation Outcomes in Patients with Cardiovascular Disease and Type 2 Diabetes Mellitus

Kashima

Kamiya

Hamazaki

et al. 2022

JCM

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The use of sodium-glucose cotransporter 2 (SGLT2) inhibitors in patients with type 2 diabetes mellitus (T2DM) has been associated with decreased skeletal muscle mass but remains unclear in patients with cardiovascular disease (CVD) undergoing comprehensive outpatient cardiac rehabilitation (CR). Therefore, this study investigates the effect of SGLT2 inhibitors on the outcomes of patients with CVD and T2DM undergoing comprehensive outpatient CR. The study included 402 patients with CVD and T2DM who participated in comprehensive outpatient CR. Physical functions (grip strength, maximal quadriceps isometric strength, usual gait speed, and 6-minute walking distance) were measured at discharge as baseline and 5 months thereafter, and the association between physical functions and SGLT2 inhibitor use was reviewed. Physical functions improved regardless of SGLT2 inhibitor use. Multiple regression analysis showed that SGLT2 inhibitor use was not associated with improvement or decline in physical functions (p ≥ 0.05). The use of SGLT2 inhibitors in patients with CVD and T2DM undergoing outpatient CR did not impair improvement in physical functions.

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Section: Discussionsupporting

confidence: 93%

Association between SGLT2 Inhibitors and Cardiac Rehabilitation Outcomes in Patients with Cardiovascular Disease and Type 2 Diabetes Mellitus

Kashima

Kamiya

Hamazaki

et al. 2022

JCM

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“…In addition, these studies are mostly small and with a great heterogeneity in terms of patient characteristics and interventions offered. Nevertheless, the results are promising and show that RT is feasible, safe, and effective 52,67,69,74,80,81. More high-quality studies are warranted in these patient cohorts.…”

Section: Discussionmentioning

confidence: 94%

“…In this context, the results of the recently published REHAB-HF trial52,69 are of great interest (n = 349, >60 yr, 53% with LVEF ≥ 45%). The prevalence of diabetes was high (53%) in this study population, and patients with diabetes scored significantly lower in physical performance and mobility at baseline than those with no diabetes 69.…”

Section: Resultsmentioning

confidence: 99%

Resistance Training in Patients With Coronary Artery Disease, Heart Failure, and Valvular Heart Disease

Bjarnason-Wehrens

Schwaab

Reiss

et al. 2022

Journal of Cardiopulmonary Rehabilitation and Prevention

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“…Effects of the study intervention on 3-month outcomes between frail and prefrail groups were analyzed using analysis of covariance, adjusting for baseline measure, clinical site, age, sex, and ejection fraction (EF) category, as in prior REHAB-HF studies. 22,23 Least-square (LS) means were reported as estimates of the intervention effects. The effect sizes for the 3-month outcomes were reported as the betweengroup difference in the LS means.…”

Section: Discussionmentioning

confidence: 99%

“…Participant characteristics were compared across study groups (prefrail vs frail) using t test for continuous variables and χ 2 tests for categorical variables in the overall cohort and within each treatment arm. Effects of the study intervention on 3-month outcomes between frail and prefrail groups were analyzed using analysis of covariance, adjusting for baseline measure, clinical site, age, sex, and ejection fraction (EF) category, as in prior REHAB-HF studies . Least-square (LS) means were reported as estimates of the intervention effects.…”

Section: Methodsmentioning

confidence: 99%

Frailty and Effects of a Multidomain Physical Rehabilitation Intervention Among Older Patients Hospitalized for Acute Heart Failure

et al. 2023

Self Cite

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ImportanceFrailty is common among older patients with acute decompensated heart failure (ADHF) and is associated with worse quality of life (QOL) and a higher risk of clinical events. Frailty can also limit recovery and response to interventions. In the Rehabilitation Therapy in Older Acute Heart Failure Patients (REHAB-HF) trial, a 3-month innovative, early, transitional, tailored, multidomain physical rehabilitation intervention improved physical function and QOL (vs usual care) in older patients with ADHF.ObjectiveTo evaluate whether baseline frailty modified the benefits of the physical rehabilitation intervention among patients with ADHF enrolled in the REHAB-HF trial and to assess the association between changes in frailty with the risk of adverse clinical outcomes on follow-up.Design, Setting, and ParticipantsThis prespecified secondary analysis of the REHAB-HF trial, a multicenter randomized clinical trial, included 337 patients 60 years and older hospitalized for ADHF. Patients were enrolled from September 17, 2014, through September 19, 2019. Participants were stratified across baseline frailty strata as assessed using modified Fried criteria. Data were analyzed from July 2021 to September 2022.InterventionsPhysical rehabilitation intervention or attention control.Main Outcomes and MeasuresPrimary outcome was the Short Physical Performance Battery (SPPB) score at 3 months. Clinical outcomes included all-cause hospitalization or mortality at 6 months.ResultsThis prespecified secondary analysis included 337 participants; 181 (53.7%) were female, 167 (49.6%) were Black, and the mean (SD) age was 72 (8) years. A total of 192 (57.0%) were frail and 145 (43.0%) were prefrail at baseline. A significant interaction was observed between baseline frailty status and the treatment arm for the primary trial end point of overall SPPB score, with a 2.6-fold larger improvement in SPPB with intervention among frail patients (2.1; 95% CI, 1.3-2.9) vs prefrail patients (0.8; 95% CI, −0.1 to 1.6; P for interaction = .03). Trends consistently favored a larger intervention effect size, with significant improvement among frail vs prefrail participants for 6-minute walk distance, QOL, and the geriatric depression score, but interactions did not achieve significance.Conclusions and RelevanceIn this prespecified secondary analysis of the REHAB-HF trial, patients with ADHF with worse baseline frailty status had a more significant improvement in physical function in response to an innovative, early, transitional, tailored, multidomain physical rehabilitation intervention than those who were prefrail.Trial RegistrationClinical Trials.gov Identifier: NCT02196038

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Physical Rehabilitation in Older Patients Hospitalized with Acute Heart Failure and Diabetes: Insights from REHAB-HF

Cited by 8 publications

References 41 publications

Association between SGLT2 Inhibitors and Cardiac Rehabilitation Outcomes in Patients with Cardiovascular Disease and Type 2 Diabetes Mellitus

Association between SGLT2 Inhibitors and Cardiac Rehabilitation Outcomes in Patients with Cardiovascular Disease and Type 2 Diabetes Mellitus

Resistance Training in Patients With Coronary Artery Disease, Heart Failure, and Valvular Heart Disease

Frailty and Effects of a Multidomain Physical Rehabilitation Intervention Among Older Patients Hospitalized for Acute Heart Failure

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