Key result
Acute-phase rehabilitation initiation within 2 days of admission was associated with lower in-hospital mortality (9.0% vs. 11.2%; OR 0.778, 95% CI 0.704-0.860; p<0.001).
Why the study?
Data on the potential benefit of acute-phase rehabilitation initiation in very old (aged ≥90) patients with acute heart failure were scarce.
Does acute-phase rehabilitation initiation reduce in-hospital mortality and improve short-term outcomes in patients aged ≥90 years with acute heart failure?
Cohort (n=41,896)
Yes
Does acute-phase rehabilitation initiation reduce in-hospital mortality and improve short-term outcomes in patients aged ≥90 years with acute heart failure?
Odds Ratio: 0.778 (95% CI 0.704–0.86)
Absolute Event Rate: 9% vs 11.2%
p-value: p=<0.001
Early initiation of acute-phase rehabilitation within 2 days of admission is associated with reduced in-hospital mortality and improved short-term outcomes in very elderly patients (≥90 years) with acute heart failure.
May support early rehabilitation in nonagenarian AHF; hypothesis-generating and requires prospective RCTs before practice change.
BACKGROUND: Data on the potential benefit of acute-phase rehabilitation initiation in very old (aged ≥90) patients with acute heart failure (AHF) have been scarce. METHODS: We retrospectively analyzed data from the Diagnosis Procedure Combination database, which is a nationwide inpatient database. This study included patients hospitalized for heart failure (HF) from January 2010 to March 2018, those aged ≥90 years, who had a length of stay of ≥3 days, New York Heart Association (NYHA) class of ≥II, and had not undergone major procedures under general anesthesia. Propensity score matching and generalized linear models were used to compare in-hospital mortality, length of stay, 30-day readmission rate due to HF, all-cause 30-day readmission, and improvement in activities of daily living (ADL) between patients with and without an acute-phase rehabilitation initiation, which is defined as the rehabilitation initiation within 2 days after hospital admission. RESULTS: Acute-phase rehabilitation was initiated in 8588 of 41,896 eligible patients. Propensity score matching created 8587 pairs. Patients with acute-phase rehabilitation initiation have lower in-hospital mortality (9.0% vs. 11.2%, p < 0.001). Acute-phase rehabilitation initiation was associated with lower in-hospital mortality (odds ratio, 0.778; 95% confidence interval, 0.704-0.860). Patients with acute-phase rehabilitation initiation have a shorter median length of stay (17 days vs. 18 days, p < 0.001), lower 30-day readmission rate due to HF (5.5% vs. 6.4%, p = 0.011) and all-cause 30-day readmission (10.2% vs. 11.2%, p = 0.036), and better ADL improvement (49.7% vs. 46.9%, p < 0.001). Subgroup analysis revealed consistent results (sex, body mass index, NYHA class, and Barthel Index). CONCLUSIONS: The acute-phase rehabilitation initiation was associated with improved short-term clinical outcomes in patients aged ≥90 years with AHF.
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Ueno et al. (2023) conducted a cohort in Acute heart failure (n=41,896). Acute-phase rehabilitation initiation vs. No acute-phase rehabilitation initiation was evaluated on In-hospital mortality (OR 0.778, 95% CI 0.704-0.860, p=<0.001). Acute-phase rehabilitation initiation within 2 days of admission was associated with lower in-hospital mortality (9.0% vs. 11.2%; OR 0.778, 95% CI 0.704-0.860; p<0.001).
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