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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References
- Global, regional, and national incidence, prevalence, and years lived with disability for 301 acute and chronic diseases and injuries in 188 countries, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013.Lancet. 2015; 386: 743-800
- Heart disease and stroke statistics—2021 update: a report from the American Heart Association.Circulation. 2021; 143: e254-e743
- Temporal trends and patterns in heart failure incidence: a population-based study of 4 million individuals.Lancet. 2018; 391: 572-580
- Temporal trends in prevalence and prognostic implications of comorbidities among patients with acute decompensated heart failure: the ARIC study community surveillance.Circulation. 2020; 142: 230-243
- National trends in heart failure mortality in men and women, United Kingdom, 2000-2017.Eur J Heart Fail. 2021; 23: 3-12
- Survival of patients with chronic heart failure in the community: a systematic review and meta-analysis.Eur J Heart Fail. 2019; 21: 1306-1325
- Long-term outcomes of acute heart failure: where are we now?.J Am Coll Cardiol. 2017; 70: 2487-2489
- Diagnoses and timing of 30-day readmissions after hospitalization for heart failure, acute myocardial infarction, or pneumonia.JAMA. 2013; 309: 355-363
- Inpatient mortality risk scores and postdischarge events in hospitalized heart failure patients: a community-based study.Circ Heart Fail. 2017; 10e003926
- In-hospital and postdischarge mortality among patients with acute decompensated heart failure hospitalizations ending on the weekend versus weekday: the ARIC Study Community Surveillance.J Am Heart Assoc. 2019; 8e011631
- Frequency, trends and institutional variation in 30-day all-cause mortality and unplanned readmissions following hospitalisation for heart failure in Australia and New Zealand.Eur J Heart Fail. 2021; 23: 31-40
- Temporal trends in mortality and readmission after acute heart failure: a systematic review and meta-regression in the past four decades.Eur J Heart Fail. 2021; 3: 420-431
- Clinical phenotypes and outcome of patients hospitalized for acute heart failure: the ESC Heart Failure Long-Term Registry.Eur J Heart Fail. 2017; 19: 1242-1254
- Trends in survival after a diagnosis of heart failure in the United Kingdom 2000-2017: population based cohort study.BMJ. 2019; 364: l223
- Characteristics of acute heart failure hospitalizations based on presenting severity.Circ Heart Fail. 2019; 12e005171
- Global estimates of the need for rehabilitation based on the Global Burden of Disease study 2019: a systematic analysis for the Global Burden of Disease Study 2019.Lancet. 2021; 396: 2006-2017
- Activities of daily living and outcomes in heart failure.Circ Heart Fail. 2015; 8: 261-267
- Evaluation of a transitional care program after hospitalization for heart failure in an integrated health care system.JAMA Netw Open. 2020; 3e2027410
- Current status of cardiac rehabilitation.J Am Coll Cardiol. 2008; 51: 1619-1631
- Home-based cardiac rehabilitation: a scientific statement from the American Association of Cardiovascular and Pulmonary Rehabilitation, the American Heart Association, and the American College of Cardiology.Circulation. 2019; 140: e69-e89
- Physical rehabilitation for older patients hospitalized for heart failure.N Engl J Med. 2021; 385: 203-216
- Addition of supervised exercise training to a post-hospital disease management program for patients recently hospitalized with acute heart failure: the EJECTION-HF randomized phase 4 trial.JACC Heart Fail. 2018; 6: 143-152
- Review of trials on exercise-based rehabilitation interventions following acute decompensated heart failure: observations from the WHO International Clinical Trials Registry Platform.J Cardiopulm Rehabil Prev. 2021; 41: 214-223
- Cardiac prevention and rehabilitation “3.0”: from acute to chronic phase. Position paper of the Italian Association for Cardiovascular Prevention and Rehabilitation (GICR-IACPR).Monaldi Arch Chest Dis. 2018; 88: 1004-1025
Gazzetta Ufficiale della Repubblica Italiana. Piano d'indirizzo per la riabilitazione. 2011;50:163-82.
- Association between physical activity levels in the hospital setting and hospital-acquired functional decline in elderly patients.JAMA Netw Open. 2020; 3e1920185
- Efficacy and safety of exercise training in patients with chronic heart failure: HF-ACTION randomized controlled trial.JAMA. 2009; 301: 1439-1450
- Cardiac resynchronization in chronic heart failure.N Engl J Med. 2002; 346: 1845-1853
- Factors influencing the predictive power of models for predicting mortality and/or heart failure hospitalization in patients with heart failure.JACC Heart Fail. 2014; 2: 429-436
- Risk prediction in patients with heart failure: a systematic review and analysis.JACC Heart Fail. 2014; 2: 440-446
- Clinical significance of Get With the Guidelines-Heart Failure risk score in patients with chronic heart failure after hospitalization.J Am Heart Assoc. 2018; 7e008316
- Multiple imputation using chained equations: issues and guidance for practice.Stat Med. 2011; 30: 377-399
- Impact of in-hospital cardiac rehabilitation on mortality and readmissions in heart failure: a population study in Lombardy, Italy, from 2005 to 2012.Eur J Prev Cardiol. 2019; 26: 808-817
- Short-term change in distance walked in 6 min is an indicator of outcome in patients with chronic heart failure in clinical practice.J Am Coll Cardiol. 2006; 48: 99-105
- Quality improvement strategies to optimise transition of patients with heart failure to independent living: protocol for a scoping review.BMJ Open. 2014; 4e005711
- Prognostic significance and determinants of the 6-min walk test in patients with heart failure and preserved ejection fraction.JACC Heart Fail. 2015; 3: 459-466
- 6-min walk test provides prognostic utility comparable to cardiopulmonary exercise testing in ambulatory outpatients with systolic heart failure.J Am Coll Cardiol. 2012; 60: 2653-2661
- Prediction of mortality and morbidity with a 6-minute walk test in patients with left ventricular dysfunction.SOLVD Investigators. JAMA. 1993; 270: 1702-1707
- Reliability, construct validity and determinants of 6-minute walk test performance in patients with chronic heart failure.Int J Cardiol. 2017; 240: 285-290
- Nature of cardiac rehabilitation around the globe.EClinicalMedicine. 2019; 13: 46-56
- Validation of exercise capacity as a surrogate endpoint in exercise-based rehabilitation for heart failure: a meta-analysis of randomized controlled trials.JACC Heart Fail. 2018; 6: 596-604
- Heart failure management in skilled nursing facilities: a scientific statement from the American Heart Association and the Heart Failure Society of America.Circ Heart Fail. 2015; 8: 655-667
- Improving postdischarge outcomes in acute heart failure.Am J Ther. 2018; 25: e475-e486
Article info
Publication history
Published online: November 02, 2021
Accepted:
October 6,
2021
Received:
July 30,
2021
Footnotes
Disclosures: none.
Identification
Copyright
© 2021 by the American Congress of Rehabilitation Medicine.
