4.5 Article

Rehabilitation Intervention in Older Patients With Acute Heart Failure With Preserved Versus Reduced Ejection Fraction

期刊

JACC-HEART FAILURE
卷 9, 期 10, 页码 747-757

出版社

ELSEVIER SCI LTD
DOI: 10.1016/j.jchf.2021.05.007

关键词

aging; heart failure; HFpEF; physical function; rehabilitation

资金

  1. National Institutes of Health [R01AG045551, R01AG18915, P30AG021332, P30AG028716, U24AG059624]
  2. Kermit Glenn Phillips II Chair in Cardiovascular Medicine
  3. Oristano Family Fund at Wake Forest School of Medicine
  4. Abbott
  5. American Regent
  6. Amgen
  7. AstraZeneca
  8. Bayer
  9. Boehringer Ingelheim
  10. Boston Scientific
  11. Cytokinetics
  12. Medtronic
  13. Merck
  14. Novartis
  15. Roche
  16. Sanofi
  17. Vifor
  18. CVRx
  19. Fibrogen
  20. NovoNordisk
  21. Corvia
  22. Janssen Research and Development
  23. Lundbeck
  24. Monteris

向作者/读者索取更多资源

Older patients with heart failure with preserved ejection fraction (HFpEF) had significantly worse impairments at baseline compared to those with heart failure with reduced ejection fraction (HFrEF), and may derive greater benefits from the intervention.
OBJECTIVES This study assessed for treatment interactions by ejection fraction (EF) subgroup (>= 45% [heart failure with preserved ejection fraction (HFpEF); vs <45% [heart failure with reduced ejection fraction (HFrEF)]). BACKGROUND The REHAB-HF trial showed that an early multidomain rehabilitation intervention improved physical function, frailty, quality-of-life, and depression in older patients hospitalized with acute decompensated heart failure (ADHF). METHODS Three-month outcomes were: Short Physical Performance Battery (SPPB), 6-min walk distance (6MWD), and Kansas City Cardiomyopathy Questionnaire (KCCQ). Six-month end points included all-cause rehospitalization and death and a global rank of death, all-cause rehospitalization, and SPPB. Prespecified significance level for interaction was P # 0.1. RESULTS Among 349 total participants, 185 (53%) had HFpEF and 164 (47%) had HFrEF. Compared with HFrEF, HFpEF participants were more often women (61% vs 43%) and had significantly worse baseline physical function, frailty, quality of life, and depression. Although interaction P values for 3-month outcomes were not significant, effect sizes were larger for HFpEF vs HFrEF: SPPB +1.9 (95% CI: 1.1-2.6) vs thorn1.1 (95% CI: 0.3-1.9); 6MWD +40 meters (95% CI: 9 meters-72 meters) vs +27 (95% CI: -6 meters to 59 meters); KCCQ +9 (2-16) vs +6 (-2 to 14). All-cause rehospitalization rate was nominally lower with intervention in HFpEF but not HFrEF [effect size 0.83 (95% CI: 0.64-1.09) vs 0.99 (95% CI: 0.74-1.33); interaction P = 0.40]. There were significantly greater treatment benefits in HFpEF vs HFrEF for all-cause death [interaction P = 0.08; intervention rate ratio 0.63 (95% CI: 0.25-1.61) vs 2.21 (95% CI: 0.78-6.25)], and the global rank end point (interaction P = 0.098) with benefit seen in HFpEF [probability index 0.59 (95% CI: 0.50-0.68)] but not HFrEF. CONCLUSIONS Among older patients hospitalized with ADHF, compared with HFrEF those with HFpEF had significantly worse impairments at baseline and may derive greater benefit from the intervention. (C) 2021 by the American College of Cardiology Foundation.

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