Background: In the multicenter, randomized REHAB-HF (Rehabilitation Therapy in Older Acute Heart Failure Patients) trial, older hospitalized patients with decompensated heart failure (HF) who participated in an early, transitional, tailored, progressive, and multidomain physical rehabilitation intervention demonstrated significant improvements in physical function and quality of life (QOL). Prevalence of depression is high in HF, but it is unknown whether older patients with concomitant HF and depression who undergo rehabilitation have similar improvements in outcomes. Objective: We assessed for physical function and QOL differences in intervention outcomes among patients with and without baseline depression. Methods: REHAB-HF included patients > 60 years hospitalized for HF and randomized them to a physical rehabilitation intervention or attention control. Participants were stratified across baseline depression status using the Geriatric Depression Scale (GDS, ≥5). Primary outcomes included physical function measured with the Short Physical Performance Battery (SPPB) score and health-related (HR) QOL measured with the Kansas City Cardiomyopathy Questionnaire (KCCQ) at 3 months. Clinical outcomes included all-cause/HF hospitalizations or mortality at 6 months. Results: Out of 343 participants (mean±SD age 73±8, 52.2% female), 44.6% (n=153) had depression. Those with depression had higher BMI (34.2±8.8 vs. 31.8±8.2, p=0.01), had EF > 45% (61.4% vs. 47.9%, p=0.01) and were frail (54.9% vs. 38.9%, p=0.003). Adherence to rehab intervention did not differ for participants with and without depression. Participants demonstrated improvements in SPPB with the intervention with (Effect Size 1.4; 95% CI 0.5, 2.3; p=0.002) and without (1.5; 0.7, 2.3; p=0.0001) depression. There was a trend toward a larger intervention effect size for HRQOL, with significant improvement among patients with (11.6; 3.9, 19.3; p=0.003) vs. without depression (3.2; -3.6, 10.0, p=0.4) as measured by KCCQ. No differences in clinical outcomes were seen. Conclusions: Older HF patients with and without depression had similar adherence and demonstrated significant improvements in physical function in response to intervention. Those with depression also demonstrated significant improvements in HRQOL. These findings suggest that physical rehabilitation may improve physical function and HRQOL in older patients with comorbid depression during recovery from acute HF decompensation.
Islam et al. (Tue,) studied this question.