5MinuteConsult Journal Club
Improved Quality of Life and Longevity by Physical Rehab for Heart Failure
N Engl J Med 2021 May 16; [e-pub]. (https://doi.org/10.1056/NEJMoa2026141)
A multicenter, randomized, controlled trial of patients recently hospitalized for decompensated heart failure evaluated a rehabilitation program of 36 sessions in addition to usual care for 349 patients. It focused on four physical-function domains (strength, balance, mobility, and endurance). The average age was 72 years with 97% of patients considered frail or prefrail; the mean number of coexisting conditions was five.
The outcomes at 3 months found the intervention improved balance scores and on average resulted in an additional 30 meters on a 6-minute walking test as well as lower geriatric depression scores.
At 6 months, there were significantly fewer rehospitalization rates and lower rates in falls and falls with injuries. There were slightly more deaths in the intervention group (21 vs 16) but its significance was unclear.
Other trials of physical rehabilitation have been done, but few have tracked depression and frailty. Those studies did not show an increase (nor decrease) in all-cause mortality rate. But even if rehabilitation has no mortality benefit, it certainly has the potential for improving quality of life among this very high-risk population. Unlike the DOAC’s, ACEi’s, diuretics and implantable defibrillators, rehab improves both mental and physical functionality. In a population so frail, making a referral for physical rehab is a worthwhile investment of time and energy, even if it does not (yet) decrease mortality.
More from 5MinuteConsult
Heart Failure, Acutely Decompensated; Heart Failure Exercise Guide
Contributed by Frank J. Domino, MD, June 2, 2021