Exercise training in recently hospitalized heart failure patients enrolled in a disease management programme: design of the EJECTION-HF randomized controlled trial

Mudge, Alison; Denaro, Charles; Scott, Adam; Atherton, J.; Meyers, Deborah E.; Marwick, Thomas H.; Adsett, Julie; Mullins, Robert; Suna, Jessica; Scuffham, Paul Anthony; O’Rourke, Peter

doi:10.1093/eurjhf/hfr139

Cited by 23 publications

(19 citation statements)

References 32 publications

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“…We have incorporated several novel features into our study design to meet the specific needs of older, frail recently hospitalized HF patients that distinguishes REHAB-HF from prior 29, 30 and ongoing 56–58 investigations of exercise training in HF. During our pilot study, we observed unexpectedly severe impairments in all functional domains, including balance and mobility.…”

Section: Discussionmentioning

confidence: 99%

Rehabilitation Therapy in Older Acute Heart Failure Patients (REHAB-HF) trial: Design and rationale

Reeves

Whellan

Duncan

et al. 2017

American Heart Journal

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Background Acute decompensated heart failure (ADHF) is a leading cause of hospitalization in older persons in the United States. Reduced physical function and frailty are major determinants of adverse outcomes in older patients with hospitalized ADHF. However, these are not addressed by current heart failure (HF) management strategies and there has been little study of exercise training in older, frail HF patients with recent ADHF. Hypothesis Targeting physical frailty with a multi-domain structured physical rehabilitation intervention will improve physical function and reduce adverse outcomes among older patients experiencing a HF hospitalization. Study Design Rehabilitation Therapy in Older Acute Heart Failure Patients (REHAB-HF) is a multi-center clinical trial in which 360 patients ≥ 60 years hospitalized with ADHF will be randomized either to a novel 12-week multi-domain physical rehabilitation intervention or to attention control. The goal of the intervention is to improve balance, mobility, strength and endurance utilizing reproducible, targeted exercises administered by a multi-disciplinary team with specific milestones for progression. The primary study aim is to assess the efficacy of the REHAB-HF intervention on physical function measured by total Short Physical Performance Battery score. The secondary outcome is 6-month all-cause rehospitalization. Additional outcome measures include quality of life and costs. Conclusions REHAB-HF is the first randomized trial of a physical function intervention in older patients with hospitalized ADHF designed to determine if addressing deficits in balance, mobility, strength and endurance improves physical function and reduces rehospitalizations. It will address key evidence gaps concerning the role of physical rehabilitation in the care of older patients, those with ADHF, frailty, and multiple comorbidities.

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Section: Discussionmentioning

confidence: 99%

Rehabilitation Therapy in Older Acute Heart Failure Patients (REHAB-HF) trial: Design and rationale

Reeves

Whellan

Duncan

et al. 2017

American Heart Journal

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“…Patients were defined as having CHF if they had documented evidence of: 1) symptoms including dyspnea, fatigue, and/or peripheral edema; 2) physical signs of heart failure at the time of hospital admission, including increased jugular venous pressure, a displaced apex beat, the presence of a third heart sound, and/or crepitation on chest auscultation; or 3) significant radiographic and/or echocardiographic findings suggesting heart failure. 8) Patients were excluded from this study for the following reasons: terminal illness, severe cognitive dysfunction, and psychological or physical disabilities. Patients who were waiting for coronary revascularization, insertion of an implantable cardioverter defibrillator, or cardiac resynchronization therapy, were also excluded.…”

Section: Methodsmentioning

confidence: 99%

Improved Exercise Capacity After Cardiac Rehabilitation Is Associated with Reduced Visceral Fat in Patients with Chronic Heart Failure

et al. 2017

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SummaryParticipation in a comprehensive cardiac rehabilitation (CR) program has been shown to reduce mortality and improve exercise capacity and symptoms in patients with chronic heart failure (CHF). Reduced exercise capacity leads to a concomitant reduction of skeletal muscle mass and accumulation of body fat. However, it is currently unknown whether CR reduces visceral adipose tissue (VAT) and/or subcutaneous abdominal adipose tissue (SAT) in patients with CHF. In addition, the body composition associated with improved exercise capacity after CR in patients with CHF has not been previously studied. Nineteen CHF patients who were categorized as NYHA functional class II or III and had received optimal medical treatment including a CR program for 5 months were enrolled in this study. The CR program significantly increased peak VO2 and reduced B-type natriuretic peptide. In addition, fat and body composition analysis showed reductions in the visceral fat tissue (VAT) area, subcutaneous abdominal adipose tissue (SAT) area, body weight, and total fat weight after CR. There were no changes in total water weight and total muscle weight. Single regression analysis revealed that the amelioration of reduced exercise capacity seen after CR is associated with reduced VAT area but not with SAT area or body weight. In conclusion, CR reduces VAT and improves exercise capacity in patients with CHF. This suggests that reducing VAT is important for CR to be most effective in the treatment of CHF.(Int Heart J 2017; 58: 746-751)

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“…[86] The effect of exercise training on survival in HFPEF is unknown, but will be examined in the Ejection-HF trial. [87]…”

Section: Treatment Of Hfpefmentioning

confidence: 99%

Update on Heart Failure with Preserved Ejection Fraction

Hummel

Kitzman

2013

Curr Cardiovasc Risk Rep

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Heart failure with preserved ejection fraction (HFPEF) is the most common form of heart failure (HF) in older adults, and is increasing in prevalence as the population ages. Morbidity and long-term mortality in HFPEF are substantial and can be similar to HF with reduced ejection fraction (HFREF), yet HFPEF therapy remains empirical and treatment guidelines are based primarily on expert consensus. Neurohormonal blockade has revolutionized the management of HFREF, but trials in HFPEF based on this strategy have been disappointing to date. However, many recent studies have increased knowledge about HFPEF. The concept of HFPEF has evolved from a ‘cardio-centric’ model to a syndrome that may involve multiple cardiovascular and non-cardiovascular mechanisms. Emerging data highlight the importance of non-pharmacological management strategies and assessment of non-cardiovascular comorbidities. Animal models, epidemiological cohorts, and small human studies suggest that oxidative stress and inflammation contribute to HFPEF, potentially leading to development of new therapeutic targets.

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Exercise training in recently hospitalized heart failure patients enrolled in a disease management programme: design of the EJECTION-HF randomized controlled trial

Cited by 23 publications

References 32 publications

Rehabilitation Therapy in Older Acute Heart Failure Patients (REHAB-HF) trial: Design and rationale

Rehabilitation Therapy in Older Acute Heart Failure Patients (REHAB-HF) trial: Design and rationale

Improved Exercise Capacity After Cardiac Rehabilitation Is Associated with Reduced Visceral Fat in Patients with Chronic Heart Failure

Update on Heart Failure with Preserved Ejection Fraction

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