Am Heart J. 2020 Sep 18:S0002-8703(20)30262-3. doi: 10.1016/j.ahj.2020.09.009. Online ahead of print.
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 ≥65years 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 72hours of admission) and late rehabilitation (after 72hours). 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 72hours after admission while 229 (88.4%) did so 72hours after admission. Patients who received early rehabilitation had a higher rate of unassisted walking for at least 40m by 30days 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 72hours of admission was associated with a higher rate of recovery of an activity of daily living (independent walking on a level surface).