Advertisement

Physical Rehabilitation in Older Patients Hospitalized with Acute Heart Failure and Diabetes: Insights from REHAB-HF

Published:September 10, 2021DOI:https://doi.org/10.1016/j.amjmed.2021.08.001

      Abstract

      Background

      Prior studies showed an attenuated response to exercise training among patients with heart failure and type 2 diabetes mellitus. We explored the interaction between diabetes status and a novel, transitional, tailored, progressive rehabilitation intervention that improved physical function compared with usual care in the Rehabilitation Therapy in Older Acute Heart Failure Patients (REHAB-HF) trial.

      Methods

      The effect of the intervention on 3-month Short Physical Performance Battery (SPPB) (primary endpoint), 6-minute walk distance (6MWD), modified Fried frailty criteria, and quality-of-life scores (Kansas City Cardiomyopathy Questionnaire [KCCQ] and EuroQoL Visual Analogue Scale [VAS]) was compared between participants with and without diabetes. Differences in 6-month clinical outcomes were also explored.

      Results

      Of the 349 participants enrolled in REHAB-HF, 186 (53%) had diabetes. The prevalence of diabetes was higher in the intervention group (59% vs 48%). Participants with diabetes had worse baseline physical function by the SPPB and 6MWD, but similar frailty and quality-of-life scores. There was a consistent improvement with the intervention for 3-month SPPB, 6MWD, and VAS regardless of diabetes status (all interaction P value > .6), but participants with diabetes had significantly less improvement for frailty (P = .021) and a trend toward lower improvement in KCCQ (P = .11). There was no significant interaction by diabetes status for 6-month clinical event outcomes (all interaction P value > .3).

      Conclusions

      Participants with diabetes had worse baseline physical function but showed similar clinically meaningful improvements from the intervention. There was less benefit for frailty with the intervention in participants with diabetes.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to The American Journal of Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Dunlay SM
        • Givertz MM
        • Aguilar D
        • et al.
        Type 2 Diabetes Mellitus and Heart Failure: a Scientific Statement From the American Heart Association and the Heart Failure Society of America: this statement does not represent an update of the 2017 ACC/AHA/HFSA heart failure guideline update.
        Circulation. 2019; 140: e294-e324
        • Heidenreich PA
        • Albert NM
        • Allen LA
        • et al.
        Forecasting the impact of heart failure in the United States.
        Circ Hear Fail. 2013; 6: 606-619
        • From AM
        • Leibson CL
        • Bursi F
        • et al.
        Diabetes in heart failure: prevalence and impact on outcome in the population.
        Am J Med. 2006; 119: 591-599
        • Lawson CA
        • Jones PW
        • Teece L
        • et al.
        Association between type 2 diabetes and all-cause hospitalization and mortality in the UK general heart failure population.
        JACC Heart Fail. 2018; 6: 18-26
        • Fotos NV
        • Giakoumidakis K
        • Kollia Z
        • et al.
        Health-related quality of life of patients with severe heart failure: a cross-sectional multicentre study.
        Scand J Caring Sci. 2013; 27: 686-694
        • O'Connor CM
        • Whellan DJ
        • Lee KL
        • et al.
        Efficacy and safety of exercise training in patients with chronic heart failure.
        JAMA. 2009; 301: 1439
        • Banks AZ
        • Mentz RJ
        • Stebbins A
        • et al.
        Response to exercise training and outcomes in patients with heart failure and diabetes mellitus: insights from the HF-ACTION trial.
        J Card Fail. 2016; 22: 485-491
        • Kitzman DW
        • Whellan DJ
        • Duncan P
        • et al.
        Physical rehabilitation for older patients hospitalized for heart failure.
        N Engl J Med. 2021; 385: 203-216
        • Reeves GR
        • Whellan DJ
        • Duncan P
        • et al.
        Rehabilitation therapy in older acute heart failure atients (REHAB-HF) trial: design and rationale.
        Am Heart J. 2017; 185: 130-139
        • Babu AS
        • Arena R
        • Satyamurthy A
        • Padmakumar R
        • Myers J
        • Lavie CJ
        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
        • Pastva AM
        • Duncan PW
        • Reeves GR
        • et al.
        Strategies for supporting intervention fidelity in the rehabilitation therapy in older acute heart failure patients (REHAB-HF) trial.
        Contemp Clin Trials. 2018; 64: 118-127
        • Pavasini R
        • Guralnik J
        • Brown JC
        • et al.
        Short physical performance battery and all-cause mortality: systematic review and meta-analysis.
        BMC Med. 2016; 14: 215
        • Soubra R
        • Chkeir A
        • Novella J-L
        A systematic review of thirty-one assessment tests to evaluate mobility in older adults.
        Biomed Res Int. 2019; 20191354362
        • Fried LP
        • Tangen CM
        • Walston J
        • et al.
        Frailty in older adults: evidence for a phenotype.
        J Gerontol Ser A Biol Sci Med Sci. 2001; 56: M146-M157
        • McNallan SM
        • Chamberlain AM
        • Gerber Y
        • et al.
        Measuring frailty in heart failure: a community perspective.
        Am Heart J. 2013; 166: 768-774
        • McNallan SM
        • Singh M
        • Chamberlain AM
        • et al.
        Frailty and healthcare utilization among patients with heart failure in the community.
        JACC Hear Fail. 2013; 1: 135-141
        • Vidán MT
        • Blaya-Novakova V
        • Sánchez E
        • Ortiz J
        • Serra-Rexach JA
        • Bueno H
        Prevalence and prognostic impact of frailty and its components in non-dependent elderly patients with heart failure.
        Eur J Heart Fail. 2016; 18: 869-875
        • Yang X
        • Lupón J
        • Vidán MT
        • et al.
        Impact of frailty on mortality and hospitalization in chronic heart failure: a systematic review and meta-analysis.
        J Am Heart Assoc. 2018; 7 (e008251–e008251)
        • Perera S
        • Mody SH
        • Woodman RC
        • Studenski SA
        Meaningful change and responsiveness in common physical performance measures in older adults.
        J Am Geriatr Soc. 2006; 54: 743-749
        • Bohannon RW
        • Crouch R
        Minimal clinically important difference for change in 6-minute walk test distance of adults with pathology: a systematic review.
        J Eval Clin Pract. 2017; 23: 377-381
        • Wood N
        • Straw S
        • Scalabrin M
        • Roberts LD
        • Witte KK
        • Bowen TS
        Skeletal muscle atrophy in heart failure with diabetes: from molecular mechanisms to clinical evidence.
        ESC Heart Fail. 2021; 8: 3-15
        • Witte K
        • Nikitin N
        • De Silva R
        • Cleland J
        • Clark A
        Exercise capacity and cardiac function assessed by tissue Doppler imaging in chronic heart failure.
        Heart. 2004; 90: 1144-1150
        • Pandey A
        • Khera R
        • Park B
        • et al.
        Relative impairments in hemodynamic exercise reserve parameters in heart failure with preserved ejection fraction: a study-level pooled analysis.
        JACC Heart Fail. 2018; 6: 117-126
        • Jónsdóttir S
        • Andersen KK
        • Sigurðsson AF
        • Sigurðsson SB
        The effect of physical training in chronic heart failure.
        Eur J Heart Fail. 2006; 8: 97-101
        • Coats AJS
        • Forman DE
        • Haykowsky M
        • et al.
        Physical function and exercise training in older patients with heart failure.
        Nat Rev Cardiol. 2017; 14: 550-559
        • Haykowsky MJ
        • Brubaker PH
        • Stewart KP
        • Morgan TM
        • Eggebeen J
        • Kitzman DW
        Effect of endurance training on the determinants of peak exercise oxygen consumption in elderly patients with stable compensated heart failure and preserved ejection fraction.
        J Am Coll Cardiol. 2012; 60: 120-128
        • Kitzman DW
        • Brubaker PH
        • Herrington DM
        • et al.
        Effect of endurance exercise training on endothelial function and arterial stiffness in older patients with heart failure and preserved ejection fraction: a randomized, controlled, single-blind trial.
        J Am Coll Cardiol. 2013; 62: 584-592
        • Izawa KP
        • Watanabe S
        • Hiraki K
        • Osada N
        • Omiya K
        Muscle strength in heart failure male patients complicated by diabetes mellitus.
        Int J Cardiol. 2013; 168: 551-552
        • Simoneau GG
        • Ulbrecht JS
        • Derr JA
        • Becker MB
        • Cavanagh PR
        Postural instability in patients with diabetic sensory neuropathy.
        Diabetes Care. 1994; 17: 1411-1421
        • Bruce DG
        • Davis WA
        • Davis TME
        Longitudinal predictors of reduced mobility and physical disability in patients with type 2 diabetes: the Fremantle Diabetes Study.
        Diabetes Care. 2005; 28: 2441-2447
        • Peters EJG
        • Childs MR
        • Wunderlich RP
        • Harkless LB
        • Armstrong DG
        • Lavery LA
        Functional status of persons with diabetes-related lower-extremity amputations.
        Diabetes Care. 2001; 24: 1799-1804
        • Seaquist ER
        • Anderson J
        • Childs B
        • et al.
        Hypoglycemia and diabetes: a report of a workgroup of the American Diabetes Association and the Endocrine Society.
        Diabetes Care. 2013; 36: 1384-1395
        • Chapman A
        • Meyer C
        • Renehan E
        • Hill KD
        • Browning CJ
        Exercise interventions for the improvement of falls-related outcomes among older adults with diabetes mellitus: a systematic review and meta-analyses.
        J Diabetes Complications. 2017; 31: 631-645
        • Rodriguez-Mañas L
        • Laosa O
        • Vellas B
        • et al.
        Effectiveness of a multimodal intervention in functionally impaired older people with type 2 diabetes mellitus.
        J Cachexia Sarcopenia Muscle. 2019; 10: 721-733
        • Allen LA
        • Gheorghiade M
        • Reid KJ
        • et al.
        Identifying patients hospitalized with heart failure at risk for unfavorable future quality of life.
        Circ Cardiovasc Qual Outcomes. 2011; 4: 389-398
        • Yap J
        • Tay WT
        • Teng TK
        • et al.
        Association of diabetes mellitus on cardiac remodeling, quality of life, and clinical outcomes in heart failure with reduced and preserved ejection fraction.
        J Am Heart Assoc. 2019; 8e013114
        • Jang I-Y
        • Jung H-W
        • Lee HY
        • Park H
        • Lee E
        • Kim DH
        Evaluation of clinically meaningful changes in measures of frailty.
        J Gerontol A Biol Sci Med Sci. 2020; 75: 1143-1147
        • Pandey A
        • Kitzman D
        • Reeves G
        Frailty is intertwined with heart failure: mechanisms, prevalence, prognosis, assessment, and management.
        JACC Heart Fail. 2019; 7: 1001-1011
        • Pandey A
        • Kitzman D
        • Whellan DJ
        • et al.
        Frailty among older decompensated heart failure patients: prevalence, association with patient-centered outcomes, and efficient detection methods.
        JACC Heart Fail. 2019; 7: 1079-1088
        • Yoon S-J
        • Kim K-I
        Frailty and disability in diabetes.
        Ann Geriatr Med Res. 2019; 23: 165-169
        • Strain WD
        • Down S
        • Brown P
        • Puttanna A
        • Sinclair A
        Diabetes and frailty: an expert consensus statement on the management of older adults with type 2 diabetes.
        Diabetes Ther. 2021; 12: 1227-1247