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October 4, 2021European Journal of Physical and Rehabilitation MedicineOpen Access

Mild cognitive impairment in patients with acute heart failure does not limit the effectiveness of early phase II cardiac rehabilitation

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Why the study?

It was unclear whether mild cognitive impairment diminishes the benefit of early phase II cardiac rehabilitation in patients hospitalized for heart failure.

Does mild cognitive impairment diminish the benefit of early phase II cardiac rehabilitation on physical function and ADLs in older patients hospitalized for acute heart failure?

Population

204 hospitalized HF patients undergoing CR in Japan

Comparison

Patients with MCI (MMSE 19-26) vs non-MCI (MMSE >26)

Design

Case-control study

Key result

Mild cognitive impairment did not significantly limit the effectiveness of early phase II cardiac rehabilitation in patients with acute heart failure, with no significant differences in 6-minute walking distance or Barthel Index at discharge compared to patients with normal cognitive function.

Authors

JYJun-Ichi YokotaRTRen TakahashiTCTakaaki Chiba

Discussion

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Overview

Early phase II cardiac rehabilitation may benefit acute heart failure patients with mild cognitive impairment; leaves open randomized confirmation of functional gains.

Study Design

Type

Case-Control (n=204)

Multicenter

No

Structured PICO

Does mild cognitive impairment diminish the benefit of early phase II cardiac rehabilitation on physical function and ADLs in older patients hospitalized for acute heart failure?

P
Population
204 older adults (aged ≥65 years) hospitalized for acute heart failure who underwent early phase II cardiac rehabilitation, evaluated to determine if mild cognitive impairment affects rehabilitation outcomes.
E
Exposure
Guideline-based early phase II cardiac rehabilitation program (including exercise training and patient education) in patients with Mild Cognitive Impairment (MCI, MMSE 19-26).
C
Comparator
Guideline-based early phase II cardiac rehabilitation program in patients with normal cognitive function (non-MCI, MMSE >26).
O
Outcome
6-minute walking distance (6MWD), Barthel Index (BI), and Short Physical Performance Battery (SPPB) at discharge.

Main Result

Absolute Event Rate: 245.8% vs 267.3%

p-value: p=0.309

Guideline-based early phase II cardiac rehabilitation improves physical function and ADLs in older patients with acute heart failure, regardless of the presence of mild cognitive impairment.

Limitations

  • Single-center study design limits generalizability.
  • Use of MMSE to define MCI may yield different results compared to other diagnostic tools like DSM-5 or MoCA.
  • Retrospective design did not account for educational history, which may influence MMSE scores.
  • Pre-hospital 6MWD and SPPB scores were not measured, making it unclear if discharge differences were due to baseline differences or response to CR
  • Single-center study design
  • Exclusion of patients with delirium or MMSE <19

Cite This Study

Yokota et al. (2021) conducted a case-control in Acute heart failure (n=204). Mild cognitive impairment vs. Normal cognitive function was evaluated on 6-minute walking distance (6MWD) at discharge (after propensity score matching) (95% CI -20.182 to 63.108, p=0.309). Mild cognitive impairment did not significantly limit the effectiveness of early phase II cardiac rehabilitation in patients with acute heart failure, with no significant differences in 6-minute walking distance or Barthel Index at discharge compared to patients with normal cognitive function.

synapsesocial.com/papers/6a203bcc60a84f4b7dd8e705https://doi.org/10.23736/s1973-9087.21.07095-7
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