Impact of early cardiac rehabilitation after acute heart failure
F Rodrigues Santos, M Duarte Almeida, G Ferreira, G Gouveia Fiuza, O Kungel, L Afonso Santos, A Costa, I Fiuza PiresAbstract
Background
Cardiac rehabilitation (CR) is a cornerstone therapy for patients hospitalized with acute heart failure (AHF), with early inpatient rehabilitation (Phase I) contributing to functional recovery and Phase II programs playing a key role in longitudinal follow-up. However, the transition period between hospital discharge and initiation of Phase II—typically weeks—remains a vulnerable window associated with high rates of early readmission. This study aimed to evaluate the impact of an early, structured, post-discharge ambulatory CR strategy implemented in a center without a dedicated rehabilitation program.
Methods
We conducted a prospective, 1:1 randomized study with an estimated 1-year recruitment period and 2-year follow-up. Consecutive patients aged 18–80 years admitted with AHF and left ventricular ejection fraction (LVEF) <50%, autonomous in daily activities and without contraindications to light-to-moderate exercise were randomized according to date of admission. The intervention group received detailed baseline assessment, individualized exercise prescription, and in-person reassessment every two weeks with iterative adjustment of the exercise plan. The control group received standard of care with routine outpatient follow-up and guideline-directed medical therapy titration. Kansas City Cardiomyopathy Questionnaire (KCCQ) scores and 6-minute walk test (6MWT) performance were obtained at discharge and at 3 months. Emergency visits, hospitalizations, and mortality were recorded. This abstract reports the 3-month interim analysis.
Results
38 patients were included (19 control vs 19 intervention), age (66.6 vs 64.2 years), length of stay (8.6 vs 8.5 days), discharge LVEF (34.1% vs 33.8%), TAPSE (19.2 vs 18.5 mm), LV end-diastolic volume (96.9 vs 95.2 mL), BMI (27.9 vs 28.7 kg/m²), NT-proBNP (5882 vs 4863 pg/mL), initial 6MWT distance (360.9 vs 377.4 m), and KCCQ score (61.1 vs 54.4), all p>0.05. At 3 months, the intervention group achieved greater improvements in both functional capacity and quality of life: 6MWT change (+47.5 ± 31 m vs +25 ± 36 m; p=0.029) and KCCQ change (+22.2 ± 21.9 vs. +7.9 ± 9.2; p=0.017). Kaplan–Meier analyses showed lower cumulative incidence of HF-related and all-cause hospitalizations, as well as fewer emergency department visits, in the intervention group, although without statistical significance at 3 months (p=0.10) (figure 1). Mortality was 0 in the intervention group and 2 in the control group.
Conclusions
Early post-discharge ambulatory CR appears safe and demonstrates clinically meaningful improvements in functional capacity and quality of life, with encouraging early signals toward reduction in hospitalizations. Long-term results from the planned 2-year follow-up may clarify its impact on major clinical endpoints and support its implementation in centers without established center-based CR programs.For image description, please refer to the figure legend and surrounding text.