Atrial Fibrillation Status and Physical Rehabilitation in Older Patients With Acute Decompensated Heart Failure: An Analysis From the REHAB‐HF Trial

Background The REHAB‐HF (Rehabilitation Therapy in Older Acute Heart Failure Patients) trial demonstrated that a transitional, tailored, progressive rehabilitation intervention improved physical function, 6‐minute walk distance, frailty, quality‐of‐life, and depression in older patients hospitalized for acute decompensated heart failure. This analysis assessed the impact of atrial fibrillation (AF) on intervention benefits. Methods and Results Of 349 enrolled patients hospitalized for acute decompensated heart failure (mean age 72.7±8.1 years), 176 (50.4%) had AF. Participants were randomly assigned to 12‐week rehabilitation intervention or attention control. The primary outcome was Short Physical Performance Battery score at 3 months. Participants with AF were older (74.4±8.3 versus 70.8±7.5, P <0.0001) and had higher prevalence of heart failure with preserved ejection fraction (58.5% versus 47.4%, P =0.037). Patients with and without AF had similar improvement in Short Physical Performance Battery score (mean difference between rehabilitation intervention and attention control, 1.5 [95% CI, 0.6–2.3] versus 1.5 [95% CI, 0.7–2.3]; P <0.001). Those with AF had significant improvement in 6‐minute walk distance (all P <0.05) and each of the Short Physical Performance Battery domains: balance, 4‐meter walk, and chair rise. Kansas City Cardiomyopathy Questionnaire score significantly improved in patients with AF ( P <0.05) but not those without AF ( P >0.05). Interaction P values for 3‐month outcomes by AF status were not significant ( P >0.1). No significant differences were observed in deaths, all‐cause rehospitalizations, or heart failure hospitalizations at 6 months. Conclusions In older, hospitalized patients with acute decompensated heart failure, the presence of AF did not significantly affect the benefit of the rehabilitation intervention on physical function and quality of life. The intervention appears safe and effective regardless of AF status. Registration URL: https://www.clinicaltrials.gov ; Unique Identifier: NCT02196038.