Department of Medicine Sidney Kimmel Medical College at Thomas Jefferson University Philadelphia PA.
Department of Medicine Rutgers Robert Wood Johnson Medical School New Brunswick NJ.
J Am Heart Assoc. 2024 Oct;13(19):e034366. doi: 10.1161/JAHA.124.034366. Epub 2024 Sep 18.
BACKGROUND: The REHAB-HF (Rehabilitation Therapy in Older Acute Heart Failure Patients) trial demonstrated that a transitional, tailored, progressive rehabilitation intervention improved physical function, 6-minute walk distance, frailty, quality-of-life, and depression in older patients hospitalized for acute decompensated heart failure. This analysis assessed the impact of atrial fibrillation (AF) on intervention benefits. METHODS AND RESULTS: Of 349 enrolled patients hospitalized for acute decompensated heart failure (mean age 72.7±8.1 years), 176 (50.4%) had AF. Participants were randomly assigned to 12-week rehabilitation intervention or attention control. The primary outcome was Short Physical Performance Battery score at 3 months. Participants with AF were older (74.4±8.3 versus 70.8±7.5, <0.0001) and had higher prevalence of heart failure with preserved ejection fraction (58.5% versus 47.4%, =0.037). Patients with and without AF had similar improvement in Short Physical Performance Battery score (mean difference between rehabilitation intervention and attention control, 1.5 [95% CI, 0.6-2.3] versus 1.5 [95% CI, 0.7-2.3]; <0.001). Those with AF had significant improvement in 6-minute walk distance (all <0.05) and each of the Short Physical Performance Battery domains: balance, 4-meter walk, and chair rise. Kansas City Cardiomyopathy Questionnaire score significantly improved in patients with AF (<0.05) but not those without AF (>0.05). Interaction values for 3-month outcomes by AF status were not significant (>0.1). No significant differences were observed in deaths, all-cause rehospitalizations, or heart failure hospitalizations at 6 months. CONCLUSIONS: In older, hospitalized patients with acute decompensated heart failure, the presence of AF did not significantly affect the benefit of the rehabilitation intervention on physical function and quality of life. The intervention appears safe and effective regardless of AF status. REGISTRATION: URL: https://www.clinicaltrials.gov; Unique Identifier: NCT02196038.
背景：REHAB-HF（老年急性心力衰竭患者康复治疗）试验表明，过渡性、量身定制、渐进性康复干预可改善身体功能、6 分钟步行距离、虚弱、生活质量和抑郁，在因急性失代偿性心力衰竭住院的老年患者中。本分析评估了心房颤动（AF）对干预益处的影响。
方法和结果：在 349 名因急性失代偿性心力衰竭住院的患者（平均年龄 72.7±8.1 岁）中，176 名（50.4%）患有 AF。参与者被随机分配到 12 周的康复干预或对照治疗。主要结局是 3 个月时的简短体能测试电池评分。患有 AF 的参与者年龄更大（74.4±8.3 岁比 70.8±7.5 岁，<0.0001），心力衰竭射血分数保留率更高（58.5%比 47.4%，=0.037）。患有和不患有 AF 的患者在简短体能测试电池评分方面有相似的改善（康复干预与对照治疗之间的平均差异，1.5[95%CI，0.6-2.3]比 1.5[95%CI，0.7-2.3]；<0.001）。AF 患者的 6 分钟步行距离显著改善（均<0.05），简短体能测试电池的各个领域均有改善：平衡、4 米步行和椅子上升。堪萨斯城心肌病问卷评分在 AF 患者中显著改善（<0.05），但在非 AF 患者中没有改善（>0.05）。AF 状态的 3 个月结局的交互值均不显著（>0.1）。在 6 个月时，未观察到死亡、全因再住院或心力衰竭住院的差异。
结论：在因急性失代偿性心力衰竭住院的老年患者中，AF 的存在并不显著影响康复干预对身体功能和生活质量的益处。该干预措施似乎是安全有效的，与 AF 状态无关。
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