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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
Open accessAbstract
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. 2,19,20”
From Semaglutide in Patients with Heart Failure with Preserved Ejection Fraction and Obesity (2023) · cites this paper as [20]
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“This result may be explained by the high prevalence of depression in HF patients with preserved LVEF (HFpEF) (20).”
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“…of race on the effect of the intervention on 3-month outcomes (SPPB total and component scores, Montreal Cognitive Assessment, Geriatric Depression Scale-15, Fried Frailty Criteria, 6-Minute Walk Distance, gait speed, Kansas City Cardiomyopathy Questionnaire, and EuroQol 5- Dimension- 5-Level…”
InfluentialSelf-citationAssociations of Depression, Antidepressants with Atrial Fibrillation Risk in HFpEF Patients
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Frailty Phenotype and Cardiovascular vs Noncardiovascular Mortality
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“4 Several factors have been implicated in the rise of cases, including increases in life expectancy, cardiac comorbidities like coronary artery disease and atrial fibrillation and non-cardiac comorbidities like obesity, metabolic disease and diabetes.”
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Frailty and Its Implications in Heart Failure with Reduced Ejection Fraction
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Insuficiencia cardíaca con fracción de expulsión preservada: el lado oscuro de una vieja enfermedad
Garaygordobil, D. A., Mendoza, J. A. F., Guerrero-Pando, C., Cabello‐López, A., Martínez-Amezcua, P., Gopar‐Nieto, R., Alonso-Vázquez, A. I., Delgado-Cruz, I. V., & Arias‐Mendoza, A. (2019) · Archivos de cardiología de México · doi:10.24875/acm.19000170 · Cited by 1
The Year in Cardiothoracic and Vascular Anesthesia: Selected Highlights from 2021
Martin, A. K., Feinman, J. W., Bhatt, H. V., Subramani, S., Malhotra, A. K., Townsley, M. M., Fritz, A. V., Sharma, A., Patel, S. J., Zhou, E., et al. (2021) · Journal of Cardiothoracic and Vascular Anesthesia · doi:10.1053/j.jvca.2021.10.011 · Cited by 1
Clinical and Genetic Aspects of Depression Comorbid Coronary Heart Disease
Dolzhikov, A. V., Troshina, D. V., Голимбет, В. Е., & Volel, B. A. (2023) · Psikhiatriya · doi:10.30629/2618-6667-2022-20-4-115-127 · Cited by 1
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“In contrast, a previous study reported that HF with preserved EF (HFpEF) is associated with greater depression compared to HF with reduced EF [5].”
ResultExercise in Specific Diseases: Heart Failure with Preserved Ejection Fraction
Upadhya, B., Edelmann, F., & Kitzman, D. W. (2020) · Springer eBooks · doi:10.1007/978-3-030-35374-2_45
Self-citationResearch Progress on Cognitive Frailty in Elderly Patients with Heart Failure
Xu, J., Zhang, Y., Ding, C., & Lai, J. (2023) · Journal of Innovations in Medical Research · doi:10.56397/jimr/2023.08.02
Godfrey, S., Pandey, A., & Warraich, H. J. (2023) · JAMA Cardiology · doi:10.1001/jamacardio.2023.3360
Self-citationAn assessment of the quality of life in chronic heart failure patients
Bobčíková, K., & Bužgová, R. (2023) · Pielegniarstwo XXI wieku / Nursing in the 21st Century · doi:10.2478/pielxxiw-2023-0039
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“In recent years, the assessment of muscle mass and nutritional status has been shown to influence life expectancy and ADLs (Honda et al., 2016; Konishi et al., 2023; Warraich et al., 2018).”
The Roles of Nutrition, Frailty, and Age
Bhat, G., & Yost, G. L. (2024) · Springer eBooks · doi:10.1007/978-3-030-86172-8_27-1
How to Assess the Functional Impact of Atrial Fibrillation in Patients With Heart Failure
Kataoka, N., & Imamura, T. (2025) · Clinical Cardiology · doi:10.1002/clc.70140
ANMCO position paper: diagnosis and treatment of heart failure with preserved systolic function
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“In line with this finding decompensated HF is accompanied by high impairments of physical functioning [40] and physical limitations as well as the need for hospitalization are both associated with higher depressive and anxious symptoms [6, 40].”
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“Data indicate that providers do not recognise symptoms of depression in 50% of HF cases (Warraich et al., 2018).”
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“Yet patients with HF feel insufficiently supported by their medical teams [3], perhaps in part because symptoms other than dyspnea often go unaddressed [4].”
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Psychotherapy vs antidepressants in heart failure: Impact of adherence
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Depression and Heart Failure With Preserved Ejection Fraction: An Inflammatory Perspective
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“Notably, only 16 % of all participants had a documented clinical diagnosis of depression, indicating the frequent neglect of depressive symptoms in most HF patients [21].”
Metadata
- 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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