Abstract 16963: A Novel Rehabilitation Intervention for Older Patients with Acute Decompensated Heart Failure: the REHAB-HF Pilot Study

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Gordon R Reeves ◽  
Mahesh J Patel ◽  
David J Whellan ◽  
Christopher O’Connor ◽  
Joel D Eggebeen ◽  
...  
Keyword(s):  
Heart Failure ◽  
Pilot Study ◽  
Physical Function ◽  
Older Patients ◽  
Acute Decompensated Heart Failure ◽  
Decompensated Heart Failure ◽  
Secondary Outcome ◽  
Post Discharge ◽  
Rehabilitation Intervention ◽  
Standardized Measure

Introduction: Exercise training improves outcomes in patients with chronic, stable heart failure (HF). However, little is known regarding patients with acute decompensated HF (ADHF) who are typically elderly, frail, with multiple co-morbidities and frequent rehospitalizations. Hypothesis: A novel rehabilitation intervention in older patients hospitalized for ADHF will be feasible and safe, improve physical function and reduce rehospitalizations. Methods: This was a 3-site, randomized, attention-controlled pilot study of a tailored, progressive, multi-domain (strength, balance, mobility and endurance) rehabilitation intervention beginning in the hospital and continuing for 12 weeks post-discharge. The primary outcome was the Short Physical Performance Battery (SPPB) score, a standardized measure of physical function in frail elderly, assessed by a blinded observer; the secondary outcome was rehospitalizations. Results: We enrolled 27 patients aged 60-98 years: 59% women, 56% African-American, 41% preserved EF. Patients had ~ 5 co-morbidities and markedly impaired physical function; > 50% were frail. Characteristics were similar between groups. Study retention (89%) and intervention adherence (93%) were excellent. Figure 1 shows change in SPPB score and 6-minute walk distance. All-cause rehospitalizations were reduced by 29% (1.16±0.35 vs. 1.64±0.39) and all-cause rehospitalization days were reduced by 47% (6.0± 2.5 vs. 11.4±2.8) at 6 month follow-up. The change in SPPB score explained 90% of the reduction in all-cause rehospitalizations. There were no adverse events related to the intervention. Conclusions: These findings support the feasibility, safety and potential efficacy of a novel multi-domain rehabilitation intervention to improve physical function and reduce rehospitalizations in older, frail ADHF patients with multiple comorbidities. An NIH-funded multi-center trial is being launched to confirm these findings.

scholarly journals Cognition, Physical Function, and Quality of Life in Older Patients With Acute Decompensated Heart Failure

2020 ◽  
Author(s):  
Amy M. Pastva ◽  
Christina E. Hugenschmidt ◽  
Dalane W. Kitzman ◽  
M. Benjamin Nelson ◽  
Gretchen A. Brenes ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Heart Failure ◽  
Physical Function ◽  
Older Patients ◽  
Acute Decompensated Heart Failure ◽  
Decompensated Heart Failure

scholarly journals A Novel Rehabilitation Intervention for Older Patients With Acute Decompensated Heart Failure

2017 ◽  
Vol 5 (5) ◽  
pp. 359-366 ◽  
Author(s):  
Gordon R. Reeves ◽  
David J. Whellan ◽  
Christopher M. O'Connor ◽  
Pamela Duncan ◽  
Joel D. Eggebeen ◽  
...  
Keyword(s):  
Heart Failure ◽  
Older Patients ◽  
Acute Decompensated Heart Failure ◽  
Decompensated Heart Failure ◽  
Rehabilitation Intervention

scholarly journals Older Patients with Acute Decompensated Heart Failure Who Live Alone: An Analysis from the REHAB-HF Trial

2021 ◽  
Author(s):  
Haider J. Warraich ◽  
Dalane W. Kitzman ◽  
M. Benjamin Nelson ◽  
Robert J. Mentz ◽  
Paul B. Rosenberg ◽  
...  
Keyword(s):  
Heart Failure ◽  
Older Patients ◽  
Acute Decompensated Heart Failure ◽  
Decompensated Heart Failure

Abstract 13677: Usefulness of 2-year Iodine-123 Metaiodobenzylguanidine-based Risk Model for the Post-discharge Risk Stratification in Acute Decompensated Heart Failure Patients With Preserved Left Ventricular Ejection Fraction

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Shunsuke Tamaki ◽  
Takahisa Yamada ◽  
Tetsuya Watanabe ◽  
Takashi Morita ◽  
Yoshio Furukawa ◽  
...  
Keyword(s):  
Heart Failure ◽  
Risk Score ◽  
Mortality Risk ◽  
Risk Model ◽  
Acute Decompensated Heart Failure ◽  
Decompensated Heart Failure ◽  
Cardiac Mortality ◽  
Post Discharge ◽  
Patients With Heart Failure ◽  
Iodine 123

Background: A four-parameter risk model including cardiac iodine-123 metaiodobenzylguanidine (MIBG) imaging and readily available clinical parameters has been recently developed for the prediction of 2-year cardiac mortality risk in patients with chronic heart failure (CHF) using a Japanese CHF database consisting of 1322 patients. However, there is no information available on the usefulness of 2-year MIBG-based cardiac mortality risk score for the prediction of post-discharge prognosis in patients with heart failure with preserved LVEF (HFpEF) who are admitted with acute decompensated heart failure (ADHF). Methods and Results: Patients' data were extracted from The Prospective mUlticenteR obServational stUdy of patIenTs with Heart Failure with Preserved Ejection Fraction (PURSUIT-HFpEF) study, which is a prospective multicenter observational registry for ADHF patients with LVEF ≥50% in Osaka. We studied 239 patients who survived to discharge. Cardiac MIBG imaging was performed just before discharge. The 2-year cardiac mortality risk score was calculated using four parameters, including age, LVEF, NYHA functional class, and the cardiac MIBG heart-to-mediastinum ratio on delayed image. The patients were stratified into three groups based on the 2-year cardiac mortality risk score: low- (<4%), intermediate- (4-12%), and high-risk (>12%) groups. The endpoint was all-cause death. During a follow-up period of 1.6±0.8 years, 33 patients had all-cause death. Multivariate Cox analysis showed that 2-year MIBG-based cardiac mortality risk score was an independent predictor of all-cause death (p=0.0009). There was significant difference in the rate of all-cause death among the three groups stratified by 2-year cardiac mortality risk score (Figure). Conclusions: In this multicenter study, the 2-year MIBG-based cardiac mortality risk score was shown to be useful for the prediction of post-discharge clinical outcome in HFpEF patients admitted for ADHF.

Outcomes related to acute decompensated heart failure admissions: A pilot study

2018 ◽  
Vol 16 (2) ◽  
pp. 52
Author(s):  
AjayKumar Mishra ◽  
Vivek Sugdeb ◽  
Anandaroop Lahiri ◽  
I Ramya
Keyword(s):  
Heart Failure ◽  
Pilot Study ◽  
Acute Decompensated Heart Failure ◽  
Decompensated Heart Failure

P773Initiation of sacubitril/valsartan and optimisation of evidence-based heart failure therapies after hospitalisation for acute decompensated heart failure: An analysis of the TRANSITION study

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
R Wachter ◽  
D Pascual-Figal ◽  
J Belohlavek ◽  
E Straburzynska-Migaj ◽  
K K Witte ◽  
...  
Keyword(s):  
Heart Failure ◽  
Acute Decompensated Heart Failure ◽  
Decompensated Heart Failure ◽  
Target Dose ◽  
Open Label ◽  
Post Discharge ◽  
Reduced Ejection Fraction ◽  
Disease Modifying ◽  
Transition Study

Abstract Background Optimisation of chronic heart failure (HF) therapy remains the key strategy to improve outcomes after hospitalisation for acute decompensated HF (ADHF) with reduced ejection fraction (HFrEF). Initiation and uptitration of disease-modifying therapies is challenging in this vulnerable patient population. We aimed to describe the patterns of treatment optimisation including sacubitril/valsartan (S/V) in the TRANSITION study. Methods TRANSITION (NCT02661217) was a randomised, open-label study comparing S/V initiation pre- vs. post-discharge (1–14 days) in patients admitted for ADHF after haemodynamic stabilisation. The primary endpoint was the proportion of patients achieving 97/103 mg S/V twice daily (bid) at 10 weeks post-randomisation. Up-titration of S/V was as per label. Information on dose of S/V and on the use of concomitant HF medication was collected at each study visit up to week 26. Results A total of 493 patients received at least one dose of S/V in the pre-discharge arm and 489 patients in the post-discharge arm. One month after randomisation, 45% of patients in the pre-d/c arm vs. 44% in the post-discharge arm used 24/26 mg bid starting dose and 42% vs. 40% were on 49/51 mg S/V bid, respectively. At week 10, 47% of patients had achieved the target dose in the pre-discharge arm vs. 51% in the post-discharge arm. At the end of the follow-up at 26 weeks, the proportion of patients on S/V target dose further increased to 53% in the pre-discharge and 61% in the post-discharge arm (Figure 1). At week 10, the mean dose of S/V was 132 mg in the pre-discharge arm and 136 mg in the post-discharge arm, and at week 26, it was 140 mg and 147 mg, respectively. Before hospital admission, 52% and 54% of the patients received a beta-blocker (BB) in the pre-discharge and post-discharge group, respectively, and 42% in both arms received a mineralcorticoid receptor antagonist (MRA). At time of discharge, 68% and 71%% of the patients received a BB and 68% and 65% an MRA, in the pre-discharge and post-discharge groups, respectively. These proportions remained stable to week 10 and week 26. Uptitration of sacubitril/valsartan Conclusions In the vulnerable post-ADHF population, initiation of S/V and up-titration to target dose was feasible within 10 weeks in half of the patients alongside with a 20% increase in the use of other disease-modifying medications that remained stable through the end of the 6-month follow-up. Acknowledgement/Funding The TRANSITION study was funded by Novartis

P762Usefulness of 2-year iodine-123 metaiodobenzylguanidine-based risk model for the post-discharge risk stratification in patients with acute decompensated heart failure

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
S Tamaki ◽  
T Yamada ◽  
T Morita ◽  
Y Furukawa ◽  
Y Iwasaki ◽  
...  
Keyword(s):  
Heart Failure ◽  
Risk Score ◽  
Mortality Risk ◽  
Risk Group ◽  
Acute Decompensated Heart Failure ◽  
Decompensated Heart Failure ◽  
Risk Scores ◽  
Mibg Imaging ◽  
Cardiac Mortality ◽  
Post Discharge

Abstract Background A four-parameter risk model including cardiac iodine-123 metaiodobenzylguanidine (MIBG) imaging and readily available clinical parameters has been recently developed for the prediction of 2-year cardiac mortality risk in patients with chronic heart failure (CHF) using a Japanese CHF database consisting of 1322 patients. On the other hand, the Acute Decompensated Heart Failure National Registry (ADHERE) and Get With The Guidelines-Heart Failure (GWTG-HF) risk scores, simple tools to predict risk of in-hospital mortality, have been reported to be predictive of post-discharge outcome in patients with acute decompensated heart failure (ADHF). However, there is no information available on the usefulness of 2-year MIBG-based cardiac mortality risk score for the prediction of post-discharge prognosis in ADHF patients and its comparison with the ADHERE and GWTG-HF risk scores. Purpose We sought to validate the predictability of the 2-year MIBG-based cardiac mortality risk score for post-discharge clinical outcome in ADHF patients, and to compare its prognostic value with those of ADHERE and GWTG-HF risk scores. Methods We studied 297 consecutive patients who were admitted for ADHF, survived to discharge, and had definitive 2-year outcomes. Venous blood sampling was performed on admission, and echocardiography and cardiac MIBG imaging were performed just before discharge. In cardiac MIBG imaging, the cardiac MIBG heart-to-mediastinum ratio (HMR) was measured from the chest anterior view images obtained at 20 and 200 min after isotope injection. The 2-year cardiac mortality risk score was calculated using four parameters, including age, left ventricular ejection fraction, NYHA functional class, and HMR on delayed image. The patients were stratified into three groups based on the 2-year cardiac mortality risk score: low- (<4%), intermediate- (4–12%), and high-risk (>12%) groups. The ADHERE and GWTG-HF risk scores were also calculated from admission data as previously reported. The predictive ability of the scores was compared using receiver operating characteristic curve analysis. The endpoint was a composite of all-cause mortality and unplanned hospitalization for worsening heart failure. Results During a follow-up period, 110 patients reached the primary endpoint. There was significant difference in the rate of primary endpoint among the three groups stratified by 2-year cardiac mortality risk score (low-risk group: 18%, intermediate-risk group: 36%, high-risk group: 64%, Figure 1A). The 2-year cardiac mortality risk score demonstrated a greater area under the curve for the primary endpoint compared to the ADHERE and the GWTG-HF risk scores (Figure 1B). Figure 1 Conclusions The 2-year MIBG-based cardiac mortality risk score is also useful for the prediction of post-discharge clinical outcome in ADHF patients, and its prognostic value is superior to those of the ADHERE and the GWTG-HF risk scores.

Sign in / Sign up

Export Citation Format

Share Document