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.
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?
Case-Control (n=204)
No
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?
Answers are grounded in this paper and cite their sources.
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.
BACKGROUND: Cardiac rehabilitation (CR) is commonly performed in patients with heart failure (HF) with mild cognitive impairment (MCI). However, whether MCI diminishes the benefit of early phase II CR is unclear. AIM: This study aimed to clarify whether MCI diminishes the benefit of early phase II CR in patients hospitalized for HF. DESIGN: The design of the work is a case-control study. SETTING: All HF patients who underwent CR in acute care hospitals in Japan from April 2016 to March 2021. POPULATION: Among the 574 patients who underwent CR, 204 were included in this study. Exclusion criteria were age <65 years, dependence for activities of daily living (ADLs) prior to admission, diagnosis of dementia or delirium, mini-mental state examination (MMSE) score at the commencement of CR<19, missing data, in-hospital death, and transfer to another department during hospitalization. METHODS: Patients were divided into two groups, those with MCI (MCI group, N.=134) and those without MCI (non-MCI group, N.=70), based on MMSE score at the commencement of CR. Cognitive impairment was defined as a score of <19. MCI was defined as an MMSE score between 19 and 26, and normal cognitive function was defined as MMSE >26. The primary outcomes were the 6-minute walking distance (6MWD), Barthel Index (BI), and Short Physical Performance Battery (SPPB). All patients underwent guideline-based CR programs. RESULTS: On admission, MCI patients had significantly lower BI (P<0.01, confidence interval [CI]: 4.9-20.4) and SPPB (P<0.01, CI: 1.1-3.1), despite being independent for ADLs before admission. In addition, 6MWD (P<0.01, CI: 31.2-97.2), BI (P=0.01, CI: 1.0-8.4), and SPPB (P<0.01, CI: 0.6-2.5) were significantly lower in the MCI group at the time of discharge. However, after propensity score matching to adjust for baseline characteristics, no significant differences in any primary outcome were found between the two groups. CONCLUSIONS: The BI, SPPB, and 6MWD improvements due to CR were similar, regardless of MCI. CLINICAL REHABILITATION IMPACT: Our results may inform the selection of appropriate rehabilitation interventions for patients with HF and MCI.
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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.
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