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Characteristics, Outcomes, and Long-Term Survival of Patients With Heart Failure Undergoing Inpatient Cardiac Rehabilitation

Published:November 02, 2021DOI:https://doi.org/10.1016/j.apmr.2021.10.014

      Highlights

      • The characteristics and outcomes of patients with heart failure (HF) admitted to inpatient cardiac rehabilitation (CR) are poorly defined.
      • This lack of knowledge may generate uncertainty about the role of inpatient CR.
      • Patients admitted to inpatient CR have a poor clinical and functional profile.
      • In patient CR is effective in improving functional capacity.
      • In patients with post-acute HF, inpatient CR is associated with improved long-term survival.

      Abstract

      Objective

      To investigate the association of cardiac rehabilitation (CR) participation with all-cause mortality after a hospitalization for heart failure (HF) and to describe the characteristics and functional and clinical outcomes of HF patients undergoing inpatient CR.

      Design

      Multicenter cohort study. The association between CR participation and all-cause mortality from discharge from the acute care setting was assessed using Cox regression analysis adjusting for established prognostic factors.

      Setting

      Six inpatient rehabilitation facilities.

      Participants

      A total of 3219 patients with HF admitted to inpatient CR between January 2013 and December 2016. Of these patients, 1455 had been transferred directly from acute care hospitals after a hospitalization for HF (CR-group 1) and 1764 had been admitted from the community due to worsening functional disability or worsening clinical conditions (CR-group 2). Serving as a control group were 633 patients not referred to CR after a hospitalization for HF served as control group (non–CR group).

      Interventions

      Cardiac rehabilitation.

      Main Outcome Measures

      Long-term mortality. Secondary outcomes were: (1) change in functional capacity, as assessed by change in 6-minute walking distance from admission to discharge; (2) clinical outcomes of the index inpatient rehabilitation admission, including in-hospital mortality and unplanned readmission to the acute care.

      Results

      Compared with the non–CR group, the adjusted hazard ratios of mortality at 1, 3, and 5 years for CR-group 1 patients were 0.82 (range, 0.68-0.97), 0.81 (range, 0.71-0.93), and 0.80 (range, 0.70-0.91). The 6-minute walking distance increased from 230-292 meters (P<.001), and 43.4% of the patients gained >50 m improvement. Overall, 2.5% of the patients died in hospital and 4.7% of the patients experienced unplanned readmissions to acute care, with significant differences between group 1 and group 2.

      Conclusions

      Our data show that inpatient CR is effective in improving functional capacity and suggest that inpatient CR provided in the earliest period after a hospitalization for HF is associated with long-term improved survival.

      List of abbreviations:

      6MWD (six-minute walking distance), 6MWT (six-minute walking test), CR (cardiac rehabilitation), HF (heart failure)

      Keywords

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