Bridging the post-hospitalization gap: a feasibility study of home-based rehabilitation in decompensated heart failure

Abstract Aims Patients hospitalized with acute decompensated heart failure (ADHF) often experience impaired physical function, reduced quality of life (QoL), and loss of independence. While current guidelines recommend rehabilitation, structured programs are lacking in Germany. Thus, this trial focuses on the feasibility of a structured, home-based rehabilitation program in prefrail and frail patients recently hospitalized for ADHF. Methods The Pilot-CRHF (trial registry number: NCT06269263) study is a monocentric, single-arm prospective interventional study including multidimensional home-based exercises targeting endurance, strength, and balance. Adherence rate, physical function (6-Minute Walk Test (6MWT), Timed-Up and Go (TUG), Berg-Balance-Scale (BBS)) and QoL (Kansas City Cardiomyopathy Questionnaire (KCCQ)) were assessed at baseline and after 12 weeks of intervention. Results 30 patients (mean age 79 ± 8; 40% female; 87% NYHA III or IV) were enrolled between March, 2024 and January, 2025. Among those, 43% had heart failure with preserved ejection fraction (HFpEF) and 57% left ventricular ejection fraction (LVEF) 50%. 24 patients (80%) completed the program. After 12 weeks, 6MWT distance improved significantly (220 ± 134 m vs. 308 ± 147 m; p0.001). TUG improved only in patients with LVEF 50% (12.1 ± 5.0 s vs. 9.7 ± 4.9 s; p=0.04). BBS remained unchanged. QoL improved significantly (KCCQ: 56 ± 16 vs. 75 ± 19; p0.001). Conclusion Home-based rehabilitation is feasible leading to clinically meaningful improvements in physical function and QoL in prefrail and frail heart failure patients, particularly those with LVEF. The results support further evaluation in a larger randomized trial.