Rehabilitation Therapy In Older Patients Hospitalized With Acute Heart Failure And Comorbid Diabetes: Insights From Rehab-hf

Introduction Prior studies showed an attenuated response to exercise training among patients with heart failure (HF) and concomitant type 2 diabetes mellitus (DM). We explored the interaction between DM status and a novel, transitional, tailored, progressive, multi-domain rehabilitation therapy intervention that improved physical function compared with usual care in the REHAB-HF trial. Methods REHAB-HF was a randomized controlled trial testing the effect of a novel multi-domain physical rehabilitation intervention initiated with patients with acute HF (regardless of EF) and continued in the outpatient setting for 36 in-person sessions. Demographics, QOL scores, and baseline physical function were compared between the patients with and without DM. 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 QOL scores (Kansas City Cardiomyopathy Questionnaire [KCCQ] and EQ5D) was compared between patients with and without DM using general linear models with adjustment for baseline measure, age, sex, clinical site, and EF category (< vs. ≥45%). Results Of the 349 patients enrolled in REHAB-HF, 182 (52%) had DM. The prevalence of DM was higher in the intervention group (58% vs 47%). Patients with DM had worse baseline functional capacity as measured by the SPPB and 6MWD, but similar frailty and QOL scores. There was a consistent benefit with the intervention for 3-month SPPB, 6MWD, and EQ5D regardless of DM status (all interaction p-value >0.7) (Table), but patients with DM had lower benefit for frailty and KCCQ (interaction P<0.1). Conclusion Compared to those without DM, patients with DM had worse baseline functional capacity (SPPB and 6MWD), but had similar benefits from the intervention. There was evidence of attenuated intervention-related benefit for frailty and KCCQ which warrants further assessment.