An intensive physical rehabilitation intervention showed the greatest effect in the frailest individuals.

Physical frailty is common among individuals with heart failure (HF) and is a predictor of poor outcomes. Whether rehabilitation can improve physical function in the population with HF and documented frailty is an open question.

REHAB-HF is a randomised trial that demonstrated benefits of a tailored progressive physical rehabilitation program on physical function after hospitalisation for acute decompensated HF (NCT02196038; N Engl J Med 2021; 385: 203-216). In this secondary analysis, the investigators compared the impact of the program among those with documented frailty (n=192; mean age, 74 years; 57% women; 57% with preserved left ventricular ejection fraction [LVEF]) and those with ‘prefrailty’ (n=145; mean age, 72 years; 50% women; 50% with preserved LVEF).

Compared with prefrail participants, those with frailty had a significantly greater improvement in the primary trial outcome of a global physical function test score at three months (an effect size of 2.1, or 58% change, in the frail cohort vs 0.8, or 21% change, in the prefrail cohort). Changes in secondary outcomes of six-minute walk and quality-of-life scores also favoured the frail cohort but did not reach statistical significance.

Comment: Although this was a secondary analysis, it should at least neutralise any therapeutic inertia founded on the misconception that frail individuals with HF have little to gain from physical rehabilitation. The regimen used in REHAB-HF – starting in the inpatient setting and three times weekly after discharge – is intensive and differs from standard cardiac rehabilitation, which could pose barriers to institutional implementation and patient adherence. Nevertheless, there is good reason to believe that, when feasible, the program could provide benefits to some of the most vulnerable individuals with HF.

Frederick A. Masoudi

Pandey A, et al. Frailty and effects of a multidomain physical rehabilitation intervention among older patients hospitalized for acute heart failure: a secondary analysis of a randomized clinical trial. JAMA Cardiol 2023; 8: 167-176.