Early exercise-based rehab in acute decompensated heart failure improved 6-minute walk distance by 30.1m (95% CI 25.2-35.1) and physical function (SPPB MD 1.33).
Does early exercise-based cardiac rehabilitation improve physical function and reduce rehospitalization in patients with acute decompensated heart failure?
Early exercise-based cardiac rehabilitation during hospitalization for acute decompensated heart failure significantly improves short-term physical function and exercise capacity.
Absolute Event Rate: 0% vs 0%
Abstract Background Elderly patients, usually with physical frailty and multiple comorbidities, have prolonged and incomplete recovery of physical function after acute decompensated heart failure (ADHF) and remain at high risk for poor outcomes. Although cardiac rehabilitation (CR) is effective for stable heart failure, its impact on ADHF patients, especially those without frailty, is unclear. Purpose We aimed to conduct a meta-analysis to assess the safety and effectiveness of early rehabilitation in patients with ADHF compared to those who do not participate in a rehabilitation program during their hospitalization. Methods We systematically searched PubMed, Embase, Cochrane, and Scopus databases for randomized controlled trials (RCTs) and observational comparing early rehabilitation in patients with ADHF during their hospitalization versus standard therapy. The outcomes analyzed were: 6-minute walk distance (6-MWD), short physical performance battery (SPPB), and all-cause rehospitalization. Statistical analyses were performed using R software version 5.4.1. We assessed mean differences (MD) for continuous outcomes and compared the results using Risk Ratio (RR) under a random effects model with 95% Confidence Intervals (CI), with a p-value 0.05 considered for statistical significance. Results A total of 7 RCTs were included, comprising 804 patients, of which 311 were allocated to the intervention group and 493 to the control group. Approximately 81% were male, with a mean age ranging from 56,8 to 80,1 years and a follow-up ranging from 2 weeks to 6 months. The 6-MWD improved significantly more in the intervention group (MD 30.1; 95% CI: 25.2 - 35.1; I²=50%, Figure 1). Also, physical function (SPPB score) showed improvement compared to the control group (MD 1.33; 95% CI: 1.13 - 1.53; I²=0%, Figure 2). Moreover, the intervention group showed favorable results regarding all causes of hospitalization, however without statistical significance probably due to a lack of power (RR 0.69; 95% CI 0.47–1.01; p = 0.058; I²=0%,). Conclusion This systematic review and meta-analysis of RCTs showed that early exercise-based cardiac rehabilitation was significantly associated with enhanced exercise capacity in patients with ADHF during hospitalization or in the early post-period.Figure 1-6-minute walk distance-exercise Figure 2- SPPB
Abraham et al. (Sat,) reported a other. Early exercise-based rehab in acute decompensated heart failure improved 6-minute walk distance by 30.1m (95% CI 25.2-35.1) and physical function (SPPB MD 1.33).