Heart failure patients benefit from rehabilitation intervention
![Large peridevice leaks after left atrial appendage occlusion (LAAO) are incredibly rare and not associated with a greater risk of adverse outcomes, according to new research published in JACC: Clinical Electrophysiology.[1] Smaller residual links are more common, however, and associated with a risk of thromboembolic and bleeding events.](/sites/default/files/styles/top_stories/public/2018-08/olderpatient-doctor.jpg.webp?itok=Cv18wcDr)
Older patients hospitalized with heart failure acute decompensated heart failure (ADHF) and preserved ejection fraction (HFpEF) had poor baseline functionality, quality of life (QOL) and depression—but responded positively to rehabilitation intervention compared with patients who had heart failure with reduced ejection fraction (HFrEF) in a study described in JACC: Heart Failure.
Researchers analyzed 349 patients from the REHAB-HF trials. The cohort included 185 (53%) patients who had HFpEF (93 intervention versus 92 control) and 164 (47%) with HFrEF.
In the HFpEF group, the intervention arm had considerably more patients with diabetes than the attention-control arm (67% vs 45%).
Regarding the HFrEF cohort, there were comparatively fewer patients with peripheral vascular disease; however, the incidence was higher in the treatment group (15% vs 2%).
In the analysis, compared with HFrEF, patients with HFpEF were mostly women (61% vs 43%) with higher BMI and systolic blood pressure.
Patients with HFpEF also had a higher burden of comorbidities, including atrial fibrillation, arthritis, sleep-disordered breathing, and depression.
In addition, all-cause rehospitalization rate was nominally lower with intervention in HFpEF but not HFrEF.
The authors observed that, in the HFpEF group, the intervention was tied to a slightly lower death rate compared with the HFrEF group, yet the event counts were small (19 deaths overall in HFpEF vs 18 deaths overall in HFrEF.
The team found the primary cause of death for HFrEF was cardiovascular, specifically HF (15 cardiovascular deaths [83%] out of 18 total deaths with 12 HF deaths [67%]).
Conversely, for HFpEF, less than 50% of deaths were linked to cardiovascular (8 [42%] out of 19 deaths) and only four (21%) were HF deaths.
In the study population, there was noteworthy heterogeneity of treatment effect by EF for the global rank end point of death plus all-cause rehospitalization, and short physical performance battery (SPPB), with treatment benefit observed in HFpEF, but not in HFrEF.
Explicitly, the within-group treatment effects were statistically significant in the HFpEF group, but not the HFrEF group, according to the authors.
“These data support a potential future phase three clinical trial to assess whether the REHAB-HF intervention improves clinical outcomes in HFpEF patients with ADHF, a large and growing population of high-risk patients for whom limited evidence-based treatments are available, wrote Robert J. Mentz, MD, Division of Cardiology, Department of Medicine, Duke University School of Medicine, and colleagues.
The authors concluded that if positive, the phase three trial could change treatment paradigms, guidelines, and CMS reimbursement policy, as well as potentially lower health care costs, improve physical function, frailty, and QOL in an underserved older population.
Read the full study here.