What is the clinical evidence from this study?

Study design: Observational. Population: Patients with clinically stable heart failure with reduced ejection fraction (HFrEF) and LVEF ≤ 40% undergoing inpatient cardiac rehabilitation (n=808). Intervention: Inpatient cardiac rehabilitation program. Primary outcome: Change in physical capacity, left ventricular ejection fraction (LVEF), NYHA class, NT-proBNP levels, psychological well-being (HADS), quality of life (KCCQ), mortality and rehospitalisation rates during rehabilitation and follow-up.

What question did this study set out to answer?

The research aims to evaluate the effects of cardiac rehabilitation on patients with reduced left ventricular function and chronic heart failure.

March 4, 2026Clinical Research in Cardiology0 citationsOpen Access

Cardiac rehabilitation in patients with reduced left ventricular function in Germany: insights from the multicentre MEDIAN Heart Failure Registry

EKE. Kutali PSP. Schüller CAC. Altmann

Key Result

Inpatient cardiac rehabilitation improved LVEF from 31.1% to 35.9% (p<0.01), increased 6-min walk distance from 306 m to 388 m (p<0.01), reduced NT-proBNP levels (466.8 to 411.6 pg/mL, p<0.01), lowered NYHA class from 2.5 to 2.1 (p<0.01), reduced HADS scores, and increased KCCQ scores, with low mortality (0.6%) and rehospitalisation (2.8%) during rehabilitation in patients with HFrEF.

Key Points

The research aims to evaluate the effects of cardiac rehabilitation on patients with reduced left ventricular function and chronic heart failure.
Analyzed data from the multicentre MEDIAN Heart Failure Registry in Germany
Assessed physical capacity and left ventricular function improvements
Evaluated psychological well-being and quality of life metrics
Monitored rehospitalisation rates during follow-up
Patients showed notable improvements in physical capacity post-rehabilitation
Left ventricular function exhibited enhancements after rehabilitation
Psychological well-being and quality of life significantly increased
Rehospitalisation rates remained low during follow-up periods

Study Design

Type

Observational (n=808)

Multicenter

Yes

Structured PICO

Does inpatient cardiac rehabilitation improve physical capacity, left ventricular function, and quality of life in patients with clinically stable HFrEF?

Population

808 patients with clinically stable heart failure with reduced ejection fraction (HFrEF, LVEF ≤ 40%), mean age 65.3 years, 16.6% female, undergoing inpatient cardiac rehabilitation across 17 German centres.

Intervention

Multimodal inpatient cardiac rehabilitation program (average duration 22.8 days) consisting of aerobic exercise training (Nordic walking, treadmill/bicycle ergometry), supervised physical therapy, education, psychological care, and nutritional counselling.

Outcome

Changes in clinical and functional status (6-min walk test, bicycle ergometry, echocardiographic LVEF, NYHA class, NT-proBNP, KCCQ, and HADS) assessed at admission, discharge, and 6 months post-discharge.surrogate

Inpatient cardiac rehabilitation in patients with HFrEF is associated with significant short-term improvements in physical capacity, LVEF, and quality of life, with benefits largely maintained at 6 months.

Limitations

Observational pre–post design without a control group limits causal inference.
Follow-up data at 6 months were self-reported with incomplete questionnaire completion introducing potential bias.
Predominantly male cohort (83%) limits generalisability to females.
Psychological improvements based on subclinical baseline values.
Heterogeneous all-comer design without consecutive inclusion may introduce selection bias.
Pharmacotherapy data may not reflect current treatment standards as data were collected in 2019–2020.
Results reflect outcomes within the German inpatient rehabilitation healthcare system, limiting external applicability.
NT-proBNP analyses limited to patients with paired admission and discharge measurements possibly causing selection bias.

Abstract

Cardiac rehabilitation was associated with improvements in physical capacity, left ventricular function, psychological well-being, and quality of life in patients with chronic heart failure, alongside low observed rehospitalisation rates during follow-up.

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Cite This Study

Kutali et al. (Mon,) conducted a observational in Patients with clinically stable heart failure with reduced ejection fraction (HFrEF) and LVEF ≤ 40% undergoing inpatient cardiac rehabilitation (n=808). Inpatient cardiac rehabilitation program was evaluated on Change in physical capacity, left ventricular ejection fraction (LVEF), NYHA class, NT-proBNP levels, psychological well-being (HADS), quality of life (KCCQ), mortality and rehospitalisation rates during rehabilitation and follow-up. Inpatient cardiac rehabilitation improved LVEF from 31.1% to 35.9% (p<0.01), increased 6-min walk distance from 306 m to 388 m (p<0.01), reduced NT-proBNP levels (466.8 to 411.6 pg/mL, p<0.01), lowered NYHA class from 2.5 to 2.1 (p<0.01), reduced HADS scores, and increased KCCQ scores, with low mortality (0.6%) and rehospitalisation (2.8%) during rehabilitation in patients with HFrEF.

synapsesocial.com/papers/69a7cdaed48f933b5eeda47c https://doi.org/https://doi.org/10.1007/s00392-026-02873-y

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