PMID- 36164731 OWN - NLM STAT- MEDLINE DCOM- 20221205 LR - 20240416 IS - 2213-1787 (Electronic) IS - 2213-1779 (Print) IS - 2213-1779 (Linking) VI - 10 IP - 12 DP - 2022 Dec TI - Obesity Status and Physical Rehabilitation in Older Patients Hospitalized With Acute HF: Insights From REHAB-HF. PG - 918-927 LID - S2213-1779(22)00425-5 [pii] LID - 10.1016/j.jchf.2022.07.008 [doi] AB - BACKGROUND: In the REHAB-HF (Rehabilitation Therapy in Older Acute Heart Failure Patients) trial, a novel, early, transitional, multidomain rehabilitation intervention improved physical function, frailty, quality of life (QOL), and depression in older patients hospitalized for acute decompensated heart failure (ADHF), but the potential impact of baseline obesity on this intervention has not been studied. OBJECTIVES: This study assessed for treatment interactions by body mass index (BMI) subgroups for a novel rehabilitation intervention in ADHF. METHODS: Three-month outcomes including Short Physical Performance Battery (SPPB) (primary outcome), 6-minute walk distance (6MWD), and Kansas City Cardiomyopathy Questionnaire (KCCQ) were assessed by baseline BMI (>/=30 kg/m(2) vs <30 kg/m(2)). Six-month end points included all-cause rehospitalization and death. All analyses were adjusted for age, sex, clinical site, and ejection fraction category, and 3-month outcomes were also adjusted for baseline measure. The prespecified significance level for treatment interaction by BMI category was P /=30 kg/m(2) and 145 (42%) <30 kg/m(2). Compared with patients with BMI <30 kg/m(2), participants with BMI >/=30 kg/m(2) were younger (age 71 +/- 7 years vs 75 +/- 9 years), more frequently women (57% vs 46%), and had significantly worse baseline physical function and QOL. Although interaction P values for 3-month outcomes by BMI were not significant (interaction P > 0.15 for overall measures), adjusted SPPB effect sizes were nominally larger for participants with BMI >/=30 kg/m(2) compared with those with BMI <30 kg/m(2): +1.7 (95% CI: 0.8-2.7) vs +1.1 (95% CI: -0.1 to 2.2). This difference in SPPB effect size was due largely to improvements in the balance component of the SPPB for participants with BMI >/=30 kg/m(2): +0.6 (95% CI: 0.2-1.0) vs 0.0 (-0.6 to 0.5) for those with BMI <30 kg/m(2) (interaction P = 0.02). In contrast, adjusted 6MWD and KCCQ effect sizes were smaller for participants with BMI >/=30 kg/m(2) compared with those with BMI <30 kg/m(2): +21 meters (-17 to 59) vs +53 meters (6-100), and +5.0 (-4 to 14) vs +11 (-0.5 to 22), respectively. There was no significant interaction by BMI for 6-month clinical outcomes (all interaction P > 0.30). CONCLUSIONS: Older patients with ADHF benefit from the rehabilitation therapy regardless of BMI. Benefits for patients with obesity may be more evident in the multidomain measure of physical function (SPPB), compared with the 6MWD or KCCQ, which may be driven, in part, by the unique aspects of the novel rehabilitation intervention. (A Trial of Rehabilitation Therapy in Older Acute Heart Failure Patients [REHAB-HF]; NCT02196038). CI - Copyright (c) 2022 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved. FAU - Peters, Anthony E AU - Peters AE AD - Division of Cardiology, Duke University School of Medicine, Durham, North Carolina, USA; Duke Clinical Research Institute, Durham, North Carolina, USA. FAU - Kitzman, Dalane W AU - Kitzman DW AD - Section on Cardiovascular Medicine, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA; Sections on Geriatrics, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA. FAU - Chen, Haiying AU - Chen H AD - Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA. FAU - Nelson, M Benjamin AU - Nelson MB AD - Section on Cardiovascular Medicine, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA. FAU - Pastva, Amy M AU - Pastva AM AD - Doctor of Physical Therapy Division, Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, North Carolina, USA. FAU - Duncan, Pamela W AU - Duncan PW AD - Department of Neurology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA. FAU - Reeves, Gordon R AU - Reeves GR AD - Novant Health Heart and Vascular Institute, Charlotte, North Carolina, USA. FAU - Upadhya, Bharathi AU - Upadhya B AD - Section on Cardiovascular Medicine, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA. FAU - Whellan, David J AU - Whellan DJ AD - Department of Medicine, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania, USA. FAU - Mentz, Robert J AU - Mentz RJ AD - Division of Cardiology, Duke University School of Medicine, Durham, North Carolina, USA; Duke Clinical Research Institute, Durham, North Carolina, USA. Electronic address: robert.mentz@duke.edu. LA - eng SI - ClinicalTrials.gov/NCT02196038 GR - R01 AG078153/AG/NIA NIH HHS/United States GR - R01 AG018915/AG/NIA NIH HHS/United States GR - U24 AG059624/AG/NIA NIH HHS/United States GR - P30 AG028716/AG/NIA NIH HHS/United States GR - P30 AG021332/AG/NIA NIH HHS/United States GR - R01 AG045551/AG/NIA NIH HHS/United States GR - T32 HL069749/HL/NHLBI NIH HHS/United States GR - U01 AG076928/AG/NIA NIH HHS/United States GR - U01 HL160272/HL/NHLBI NIH HHS/United States PT - Journal Article PT - Research Support, N.I.H., Extramural PT - Research Support, Non-U.S. Gov't DEP - 20220907 PL - United States TA - JACC Heart Fail JT - JACC. Heart failure JID - 101598241 SB - IM CIN - JACC Heart Fail. 2022 Dec;10(12):928-930. PMID: 36456065 MH - Humans MH - Female MH - Aged MH - Middle Aged MH - *Quality of Life MH - *Heart Failure MH - Stroke Volume MH - Hospitalization MH - Obesity/complications PMC - PMC10234458 MID - NIHMS1871147 OTO - NOTNLM OT - acute heart failure OT - body mass index OT - obesity OT - physical function OT - rehabilitation intervention COIS- Funding Support and Author Disclosures This study was supported by research grants from the National Institutes of Health (R01AG045551, R01AG18915, P30AG021332, P30AG028716, U24AG059624, and U01HL160272), the Kermit Glenn Phillips II Chair in Cardiovascular Medicine, and the Oristano Family Fund at Wake Forest School of Medicine. Dr Peters is supported by the National Heart Lung and Blood Institute (T32HL069749) and has stock ownership in Bristol Myers Squibb. Dr Kitzman has received honoraria outside the present study as a consultant for Bayer, Merck, Medtronic, Relypsa, Merck, Corvia Medical, Boehringer-Ingelheim, NovoNordisk, AstraZeneca, Rivus, Pfizer, and Novartis; has received grant funding outside the present study from Novartis, Bayer, NovoNordisk, and AstraZeneca; and has stock ownership in Gilead Sciences. Dr Upadhya has received research support from Novartis and Corvia. Dr Whellan has received research support and consulting fees from Amgen, CVRx, Cytokinetics, Fibrogen, Novartis, and NovoNordisk. Dr Mentz has received research support and honoraria from Abbott, American Regent, Amgen, AstraZeneca, Bayer, Boehringer Ingelheim/Eli Lilly, Boston Scientific, Cytokinetics, Fast BioMedical, Gilead, Innolife, Medtronic, Merck, Novartis, Relypsa, Respicardia, Roche, Sanofi, Vifor, Windtree Therapeutics, and Zoll. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. EDAT- 2022/09/28 06:00 MHDA- 2022/12/06 06:00 PMCR- 2023/06/01 CRDT- 2022/09/27 02:52 PHST- 2022/03/21 00:00 [received] PHST- 2022/07/04 00:00 [revised] PHST- 2022/07/06 00:00 [accepted] PHST- 2022/09/28 06:00 [pubmed] PHST- 2022/12/06 06:00 [medline] PHST- 2022/09/27 02:52 [entrez] PHST- 2023/06/01 00:00 [pmc-release] AID - S2213-1779(22)00425-5 [pii] AID - 10.1016/j.jchf.2022.07.008 [doi] PST - ppublish SO - JACC Heart Fail. 2022 Dec;10(12):918-927. doi: 10.1016/j.jchf.2022.07.008. Epub 2022 Sep 7.