Early intensive inpatient cardiac rehabilitation in heart failure: the CardioRehab Registry Experience

Background and aims Access to cardiac rehabilitation (CR) for heart failure (HF) patients in Europe is often delayed and mainly outpatient, limiting its suitability for early post-acute or highly comorbid individuals. In Italy, the policy of our national healthcare system allows early intensive inpatient CR for high-risk or unstable patients. In 2025 the CardioRehab Registry, a national prospective multicenter registry on CR in HF and coronary artery disease was launched. This preliminary analysis includes only HF patients, evaluating access timing, clinical complexity, and early outcomes, as well as program effectiveness in improving functional capacity and quality of life. Methods At the time of analysis, a descriptive evaluation was conducted on 464 patients enrolled across 9 centers; 145 patients with HF were included. Continuous variables are reported as medians (interquartile range) and categorical variables as counts and percentages. Key variables included demographics, comorbidities, index event, time to CR, acute-care length of stay, NYHA class at admission, psychological and perceived health measures, functional status, autonomy, frailty, and changes in NT-proBNP. Results Table 1 shows admission data. HF patients had a median age of 67 years (IQR 57.7–75.7) and a high comorbidity burden. Clinical complexity was substantial: 67% were admitted for recurrent events, 70% had prolonged acute-care length of stay (>10 days), and acute-phase complications were common. At CR admission, 65% were in NYHA class III–IV. Median time from the acute event to CR was 17 days, and over 75% were directly transferred from acute care to inpatient rehabilitation. Discharge data were available to date for 117 patients (80%). At discharge, an overall trend toward improvement was observed across multiple domains, including psychological status (GAD-7 from 5 to 3; PHQ-9 from 6 to 3), perceived health (EQ-VAS from 60 to 77), functional capacity (6-minute walk test distance increased from 285 m [IQR 196–383] to 375 m [IQR 284–445]), autonomy (Barthel Index increased from 85 to 100), and frailty (RCS-E from 12 to 2). At admission, median NT-proBNP was 2130 pg/mL (IQR 1060–3710); where available, discharge values showed a lower trend (1570 pg/mL, IQR 937–2770). Conclusions These preliminary real-world data show that early intensive inpatient CR is feasible in clinically unstable, highly comorbid HF patients, suggesting clinical stabilization and recovery in individuals often unsuitable for outpatient programs. Completion of the registry will enable more comprehensive outcome assessment and may help inform cost-effective cardiovascular care and European benchmarking.