Addition of Supervised Exercise Training to a Post-Hospital Disease Management Program for Patients Recently Hospitalized With Acute Heart Failure

Abstract

Supervised center-based ET was a safe, feasible addition to disease management programs with supported home exercise in patients recently hospitalized with acute HF, but did not reduce combined end-point of death or readmission. (A supervised exercise programme following hospitalisation for heart failure: does it add to disease management?; ACTRN12608000263392).

Effects of post‐discharge management on rates of early re‐admission and death after hospitalisation for heart failure

“…Our findings suggest that exercise may reduce the risk of re‐admission after hospitalisation for HF, albeit for intermediate (90‐day) rather than short term (30‐day) re‐admissions. These findings are at variance with those of a recently published randomised trial in Queensland 25 . Exercise is usually recommended for stable patients after HF, 26 but only 10% of patients in our sample received an exercise program.…”

“…These findings are at variance with those of a recently published randomised trial in Queensland. 25 Exercise is usually recommended for stable patients after HF, 26 but only 10% of patients in our sample received an exercise program. We suspect that these exercise programs were implemented later rather than early in the transition phase.…”

One-year cost-effectiveness of supervised center-based exercise training in addition to a post-discharge disease management program for patients recently hospitalized with acute heart failure: The EJECTION-HF study

“…Patients with multi-morbidity are more likely to have hospital utilisation unrelated to their HF diagnosis, which is unlikely to be impacted by the HF-directed intervention. Indeed, in our primary analysis we reported only 20% of hospital readmissions were due to HF, 11 consistent with large registry findings 25 and reflecting our 'real world' inclusion criteria in this trial. It is also possible that intense follow-up and monitoring within the ET+DMP group may have contributed to the increased hospital readmissions in this older subgroup with more co-morbidities.…”

“…Results of the primary effectiveness analysis of the EJECTION-HF trial have been reported elsewhere. 11 The trial did not show a significant reduction in the primary outcome of 12-month all-cause death or readmission, but pre-planned subgroup analysis showed a statistical interaction with age, suggesting greater benefit in participants aged less than 70 years. 11 Given these results, we aimed to assess the relative cost-effectiveness of supervised exercise training (ET) added to a post-discharge DMP (ET +DMP vs. DMP alone) among all study participants, those aged <70 years, and 70 years, to help inform post-discharge HF management practices.…”

“…We evaluated the cost-effectiveness of ET as an add-on strategy to a heart failure post-discharge DMP, using data from a multi-centre randomised controlled trial. 11,12 Given the trial primary outcome (12 month all-cause death or readmission) suggesting age as a potential effect modifier, we undertook subgroup analyses in those aged less than 70 years and older participants 11 to explore the impact of age on cost-effectiveness. Over 12 months of complete follow-up, we found that the addition of ET to a DMP was not cost-effective at AU$50,000/ QALY in the entire sample or the older subgroup, but potentially costeffective in the subgroup aged less than 70 years.…”