Physical Function, Frailty, Cognition, Depression, and Quality of Life in Hospitalized Adults ≥60 Years With Acute Decompensated Heart Failure With Preserved Versus Reduced Ejection Fraction: Insights From the REHAB-HF Trial
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Background: Older hospitalized acute decompensated heart failure (HF) patients have persistently poor outcomes and delayed recovery regardless of ejection fraction (EF). We hypothesized that impairments in physical function, frailty, cognition, mood, and quality of life (QoL) potentially contributing to poor clinical outcomes would be similarly severe in acute decompensated HF patients ≥60 years of age with preserved versus reduced EF (HFpEF and HFrEF). Methods and Results: In 202 consecutive older (≥60 years) hospitalized acute decompensated HF patients in a multicenter trial, we prospectively performed at baseline: short physical performance battery, 6-minute walk distance, frailty assessment, Geriatric Depression Scale, Montreal Cognitive Assessment, and QoL assessments. Older acute decompensated HFpEF (EF ≥45%, n=96) and HFrEF (EF <45%, n=106) patients had similar impairments in all physical function measures (short physical performance battery [5.9±0.3 versus 6.2±0.2]; 6-minute walk distance [184±10 versus 186±9 m]; and gait speed [0.60±0.02 versus 0.61±0.02 m/s]) and rates of frailty (55% versus 52%; P =0.70) and cognitive impairment (77% versus 81%; P =0.56) when adjusted for differences in sex, body mass index, and comorbidities. However, depression and QoL were consistently worse in HFpEF versus HFrEF. Depression was usually unrecognized clinically with 38% having Geriatric Depression Scale ≥5 and no documented history of depression. Conclusions: Patients ≥60 years hospitalized with acute decompensated HF patients have broad, marked impairments in physical function and high rates of frailty and impaired cognition: these impairments are similar in HFpEF versus HFrEF. Further, depression was common and QoL was reduced, and both were worse in HFpEF than HFrEF. Depression was usually unrecognized clinically. These findings suggest opportunities for novel interventions to improve these important patient-centered outcomes. Clinical Trial Registration: URL: https://www.clinicaltrials.gov . Unique identifier: NCT02196038.
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Patients with heart failure with preserved ejection fraction have an especially high burden of symptoms and physical limitations, as well as a poor quality of life.
“Patients with heart failure with preserved ejection fraction have an especially high burden of symptoms and physical limitations, as well as a poor quality of life. 2,19,20”
From Semaglutide in Patients with Heart Failure with Preserved Ejection Fraction and Obesity (2023) · cites this paper as [20]
The Discussion and Conclusion report marked physical limitations and severely reduced quality of life among patients with HFpEF; quality of life was worse than in those with HFrEF. But the study concerns adults aged ≥60 hospitalized with acute decompensated heart failure, not HFpEF patients generally, and physical impairments were similar between the two groups. The Results report more depressive symptoms in HFpEF, but do not establish an especially high overall symptom burden. (LLM, conf=0.86)
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- Authors
- Warraich, H. J., Kitzman, D. W., Whellan, D. J., Duncan, P. W., Mentz, R. J., Pastva, A. M., Nelson, M. B., Upadhya, B., & Reeves, G. R.
- Affiliations
- Duke University (US)
- Wake Forest University Health Sciences (US)
- Thomas Jefferson University (US)
- Atrium Health Wake Forest Baptist (US)
- ORCID
- Venue
- Circulation: Heart Failure
- Published
- 2018-11
- Volume
- 11
- Issue
- 11
- Pages
- e005254-e005254
- ISSN
- 1941-3289 (ISSN-L)
- 1941-3297
- PMC
- PMC6380360
- OpenAlex
- W2900728651
- Cited by
- 194
- References
- 55
- Citations by year
- 2026: 14 · 2025: 20 · 2024: 30 · 2023: 34 · 2022: 36 · 2021: 28 · 2020: 22 · 2019: 9 · 2018: 1
- FWCI
- 11.33
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Circulation Heart Failure (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institutes of Health (UL1TR001420, KL2TR001421)
- National Institute on Aging (R01AG018915, R01AG045551, P30AG021332, U24AG059624, P30AG028716)
- National Center for Advancing Translational Sciences
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Failure Treatment and Management
- Health Sciences › Medicine › Geriatrics and Gerontology › Frailty in Older Adults
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Function and Risk Factors
- Keywords
- acute decompensated heart failure, heart failure with preserved ejection fraction, heart failure with reduced ejection fraction, older adults, physical function, frailty, cognitive impairment, depression, quality of life, hospitalized patients, Short Physical Performance Battery, 6-minute walk distance, walking speed, patient-centered outcomes
- MeSH terms
- Adult, Aged, Aged, 80 and over, Cognition, Depression, Female, Heart Failure, Hospitalization, Humans, Male, Middle Aged, Quality of Life, Stroke Volume, Ventricular Dysfunction, Left
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Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
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