Acute HF patients with diabetes derive less frailty benefit from physical rehab

Older diabetic patients with acute heart failure who undergo physical rehabilitation have worse baseline physical function but demonstrate similar clinically meaningful improvements from the intervention, results of the Rehabilitation Therapy in Older Acute Heart Failure Patients (REHAB-HF) trial have shown. However, the benefit derived for frailty is lesser among those with diabetes.

The researchers compared the effect of the intervention on 3-month Short Physical Performance Battery (SPPB; primary endpoint), 6-minute walk distance (6MWD), modified Fried frailty criteria, and quality-of-life scores (Kansas City Cardiomyopathy Questionnaire [KCCQ] and EuroQoL Visual Analogue Scale [VAS]) between patients with and without diabetes. They then assessed the differences in 6-month clinical outcomes.

More than half of the participants enrolled in REHAB-HF had diabetes (186 of 349; 53 percent); prevalence of this disease was higher in the intervention group (59 percent vs 48 percent). Those with diabetes had worse baseline physical function by the SPPB and 6MWD but similar frailty and quality-of-life scores.

The intervention resulted in consistent improvement for 3-month SPPB, 6MWD, and VAS regardless of diabetes status (p_interaction>0.6 for all), but diabetic participants showed a significantly less improvement for frailty (p=0.021) and a trend toward lower improvement in KCCQ (p=0.11).

Of note, no significant interaction by diabetes status was noted for 6-month clinical event outcomes (p_interaction>0.3 for all).

“Prior studies showed an attenuated response to exercise training among patients with heart failure and type 2 diabetes mellitus,” the researchers said.