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Early cardiac rehabilitation for acute decompensated heart failure safely improves physical function (PEARL study): a randomized controlled trial [with consumer summary]
Nakaya Y, Akamatsu M, Ogimoto A, Kitaoka H
European Journal of Physical and Rehabilitation Medicine 2021 Dec;57(6):985-993
clinical trial
5/10 [Eligibility criteria: Yes; Random allocation: Yes; Concealed allocation: No; Baseline comparability: Yes; Blind subjects: No; Blind therapists: No; Blind assessors: No; Adequate follow-up: Yes; Intention-to-treat analysis: No; Between-group comparisons: Yes; Point estimates and variability: Yes. Note: Eligibility criteria item does not contribute to total score] *This score has been confirmed*

BACKGROUND: Improvements in the Short Physical Performance Battery (SPPB) rather than exercise tolerance reportedly lead to favorable prognosis in elderly patients with acute decompensated heart failure (ADHF). However, about 50% of heart failure shows heart failure with preserved ejection fraction, safe and effective interventions to improve SPPB for these types remain unclear. In addition, although a standard cardiac rehabilitation (CR) program for heart failure is widely used in Japan, whether this is sufficient to improve SPPB in elderly patients with ADHF remains unclear. AIM: This study was to evaluate whether the addition of multidisciplinary physical interventions to the standard CR program would prove effective for improving SPPB among elderly patients with ADHF regardless types of heart failure. DESIGN: Randomized, prospective study. SETTING: Patients admitted to our hospital due to ADHF in Japan. POPULATION: Elderly patients with ADHF between March 2019 and March 2020 were randomized to two groups, an Intervention group and a control group. METHODS: The control group performed standard CR. The Intervention group received balance training and resistance training and used a cycling ergometer in addition to the standard CR program. The primary outcome was the improvement in SPPB after CR. RESULTS: Seventy-five patients with ADHF were divided into the two groups (intervention group, n = 36; control group, n = 39). At baseline, both groups showed low physical performance and a high prevalence of frailty. Intervention size effect was an improvement in SPPB score of +2.2 (+3.7 +/- 1.1 versus +1.5 +/- 1.7; p < 0.001). Of the 3 components of SPPB, both gait speed and timed repeated chair rise were significantly improved in the Intervention group compared to the control group, with intervention size effect of +0.76 and +0.94, respectively (p < 0.001). Subgroup analysis of heart failure with preserved ejection fraction showed significant improvement in SPPB score in the Intervention group compared to the control group (p < 0.001). No adverse events were observed during the study period. CONCLUSIONS: A multi-faceted intervention in addition to standard CR improved physical performance among elderly patients with ADHF regardless types of heart failure.

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