Elsevier

American Heart Journal

Volume 230, December 2020, Pages 44-53
American Heart Journal

Clinical Investigation
Early rehabilitation in older patients hospitalized with acute decompensated heart failure: A retrospective cohort study

https://doi.org/10.1016/j.ahj.2020.09.009Get rights and content

Background

Although hospitalized patients with acute decompensated heart failure (ADHF) have severe physical dysfunction, little data are available on the comparative effectiveness of early versus late rehabilitation. This study examined the relationship between early compared to late rehabilitation and physical function among older patients hospitalized for ADHF.

Methods

In a retrospective cohort study, independent patients aged ≥65 years at baseline who were hospitalized for ADHF from 2012 to 2014 and underwent inpatient rehabilitation were identified using Emergency Department visit data and electronic medical records at two hospitals. Patients were classified into those who underwent early rehabilitation (initiated within 72 hours of admission) and late rehabilitation (after 72 hours). Primary outcome was length of time from admission until the patient was able to walk independently. Multivariable competing-risk regression with death as the competing event was used to adjust for potential confounding factors, and multiple imputation (MI) analysis was performed.

Results

Of 259 individuals, 30 (11.6%) commenced rehabilitation within 72 hours after admission while 229 (88.4%) did so 72 hours after admission. Patients who received early rehabilitation had a higher rate of unassisted walking for at least 40 m by 30 days after admission (hazard ratio: 8.03; 95% confidence interval: 2.15 to 29.98; P = .002 in the multivariable adjusted model) than those who received late rehabilitation. Similar findings were observed on MI analysis.

Conclusion

Early rehabilitation therapy commenced within 72 hours of admission was associated with a higher rate of recovery of an activity of daily living (independent walking on a level surface).

Section snippets

Study design and participants

The study was conducted under a retrospective cohort design. Study participants were recruited at two hospitals in Yokohama and Nagoya, Japan. Inclusion criteria were as follows: (1) age ≥65 years; (2) visit to the emergency department with ongoing acute decompensation defined as the onset or worsening of HF signs or symptoms, followed by hospitalization for acute HF diagnosed by emergency physicians and confirmed by cardiologists between 1 January 2012 and 31 December 2014; (3) receipt of

Results

From January, 2012 to December, 2014, a total of 1374 patients aged 65 years or older visited the emergency department and were hospitalized for AHF. Among these, we identified 361 patients who were ordered to receive rehabilitation therapy by physicians. Among these, 305 were independent patients who received physical rehabilitation therapy during their hospital stay. After excluding ineligible patients, 259 patients with an average age (SD) of 83.1 (7.7) years were included in this study

Discussion

This study found a relationship between early rehabilitation in ADHF and an improvement in return to independent functional status (mobility) at hospital discharge compared with late rehabilitation. The early rehabilitation group had a higher rate of achievement and required fewer days to be able to walk independently than the late rehabilitation group. Sensitivity analysis suggested that the effect of rehabilitation on walking without assistance was weakened when started later. These findings

Acknowledgements

The authors would like to thank DMC Corp. (www.dmed.co.jp) for providing (medical) English writing and editorial assistance. Additionally, the authors would like to thank the two hospitals for their involvement, the staff at each site for their support with this study, and the patients participating in the study.

Sources of funding

No extramural funding was used to support this work.

Declarations of interest

None.

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