https://doi.org/10.1007/s00392-025-02625-4
1Universitätsklinikum Schleswig-Holstein Medizinische Klinik II / Kardiologie, Angiologie, Intensivmedizin Lübeck, Deutschland; 2Curschmann Klinik Rehabilitationskrankenhaus für Kardiologie und Angiologie Timmendorfer Strand, Deutschland; 3Krankenhaus Rotes Kreuz Lübeck Geriatriezentrum Lübeck, Deutschland
Background:
Heart failure (HF) presents a growing global health challenge with high mortality rates and frequent hospitalizations, contributing to rising healthcare costs. Guideline-directed HF treatment requires integrated cross-sectoral care. Cardiological rehabilitation programs (cardio-rehab)reduce all-cause and HF-specific rehospitalization rates and improve patients' quality of life. However, only a few patients initiate rehabilitation after an index event of acute HF hospitalization.
Objectives and Methods:
The ACTIVE-HF study evaluates and optimizes rehab utilization for patients hospitalized with acute HF. This all-comers, prospective, monocentric study assesses criteria for initiating cardio- or geriatric rehabilitation and explores the feasibility of direct transfer from acute care to rehab. Data are collected during hospitalization, and rehospitalizations are tracked within a 3-month observation period post-discharge. The study consists of two main phases:
1. Prospective Analysis: 100 patients were included to collect baseline data; future evaluations will include assessment of new rehab criteria (e.g., Six-Item Screener (SIS), Timed Up and Go (TUG) test, Fried Frailty Index) for effectiveness and practicality.
2. Pilot Phase: Direct transfer of 20 patients to cardio-rehab from acute care based on updated criteria, with comparisons to non-transferred controls.
Results:
Herein we report baseline and inhospital data from the prospective analysis. We screened n=170 patients for this analysis and n=100 consented for further evaluation up to 3 months. N=70 were excluded from follow-up evaluation. Baseline analysis revealed that 60% of patients were male, with a mean age of 76,76 ± 11.97 years. Barthel Index scores indicated a moderate level of independence, with a mean score of 64,03±23.19: 39% scored above 70, 51% between 40 and 70, and 10% below 40. Regarding pre-hospitalization living settings, 62% lived at home, 29% required in-home care, 2% lived in assisted living, and 7% resided in a nursing home. HF types included HFrEF (40%), HFmrEF (27%), and HFpEF (33%). 26% were de novo HF, 69% were worsening HF, and 5% advanced HF. Risk factors were common, including arterial hypertension in 92% hyperlipidemia in 81%, atrial fibrillation in 59%, type 2 diabetes in 40% and chronic kidney disease in 70%. Laboratory results indicated a mean NT-proBNP of 8,539,5± 11118,11ng/L at admission, decreasing to 6,242±11591,11 ng/L at discharge, and an average GFR of 48.06± 23,53 ml/min, reflecting a high prevalence of chronic kidney disease among the cohort. Rehabilitation initiation was achieved in this collective in 29%, with 4% attending cardio-rehab and 25% geriatric rehab. The mean time from hospital admission to rehab initiation was 38.8 days for cardiac rehab and 5,6 days for geriatric rehab. The average hospitalization duration was 15,72 ± 13,94 days.
Conclusion:
The ACTIVE-HF study reveals substantial gaps in rehab participation after acute HF hospitalization. Although many patients had moderate to high independence and follow-up willingness, only 29% began rehab, with most discharged home without further support. Future analyses will examine outcomes for rehab participants, assess new eligibility criteria, and evaluate the effect of direct rehab transfer on recovery and rehospitalization.