SPC365

Early post-discharge ambulatory cardiac rehabilitation after acute heart failure: a randomized prospective study

Session: Sessão de Comunicações Orais 08 – Reabilitação Cardíaca como terapia: recuperação funcional na doença cardiovascular avançada
Speaker: Francisco Rodrigues Dos Santos

Congress: CPC 2026
Topic: J. Preventive Cardiology
Theme: 29. Rehabilitation and Sports Cardiology
Subtheme: 29.2 Cardiovascular Rehabilitation
Session Type: Comunicações Orais
FP Number: ---
Authors: Francisco Rodrigues dos Santos; Oliver Correia Kungel; Gonçalo Ferreira; João Gouveia Fiúza; Mariana Duarte Almeida; Luís Afonso Santos; António Costa; Inês Fiúza Pires

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:&quot;Times New Roman&quot;,serif"><strong><span style="font-family:&quot;Calibri&quot;,sans-serif">Background:</span></strong> <span style="font-size:11.0pt"><span style="font-family:&quot;Calibri&quot;,sans-serif">Cardiac rehabilitation (CR) is a cornerstone therapy for patients hospitalized with acute heart failure (AHF), with early inpatient rehabilitation (Phase I) contributing to functional recovery and Phase II programs playing a key role in longitudinal follow-up. However, the transition period between hospital discharge and initiation of Phase II&mdash;typically weeks&mdash;remains a vulnerable window associated with high rates of early readmission. This study aimed to evaluate the impact of an early, structured, post-discharge ambulatory CR strategy implemented in a center without a dedicated rehabilitation program.</span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:&quot;Times New Roman&quot;,serif"><strong><span style="font-size:11.0pt"><span style="font-family:&quot;Calibri&quot;,sans-serif">Methods:</span></span></strong><span style="font-size:11.0pt"><span style="font-family:&quot;Calibri&quot;,sans-serif"> We conducted a prospective, 1:1 randomized study with an estimated 1-year recruitment period and 2-year follow-up. Consecutive patients aged 18&ndash;80 years admitted with AHF and left ventricular ejection fraction (LVEF) &lt;50%, autonomous in daily activities and without contraindications to light-to-moderate exercise were randomized according to date of admission. The intervention group received detailed baseline assessment, individualized exercise prescription, and in-person reassessment every two weeks with iterative adjustment of the exercise plan. The control group received standard of care with routine outpatient follow-up and guideline-directed medical therapy titration. Kansas City Cardiomyopathy Questionnaire (KCCQ) scores and 6-minute walk test (6MWT) performance were obtained at discharge and at 3 months. Emergency visits, hospitalizations, and mortality were recorded. This abstract reports the 3-month </span></span><span style="font-size:11.0pt"><span style="font-family:&quot;Calibri&quot;,sans-serif">interim analysis.&nbsp;</span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:&quot;Times New Roman&quot;,serif"><strong><span style="font-size:11.0pt"><span style="font-family:&quot;Calibri&quot;,sans-serif">Results:</span></span></strong><span style="font-size:11.0pt"><span style="font-family:&quot;Calibri&quot;,sans-serif"> 38 patients were included (19 control vs 19 intervention), age (66.6 vs&nbsp;64.2 years), length of stay (8.6 vs 8.5 days), discharge LVEF (34.1% vs&nbsp;33.8%), TAPSE (19.2 vs 18.5 mm), LV end-diastolic volume (96.9 vs&nbsp;95.2 mL), BMI (27.9 vs&nbsp;28.7 kg/m&sup2;), NT-proBNP (5882 vs&nbsp;4863 pg/mL), initial 6MWT distance (360.9 vs&nbsp;377.4 m), and KCCQ score (61.1 vs&nbsp;54.4), all p&gt;0.05. At 3 months, the intervention group achieved greater improvements in both functional capacity and quality of life: 6MWT change (+47.5 &plusmn; 31 m vs +25 &plusmn; 36 m; p=0.029) and KCCQ change (+22.2 &plusmn; 21.9 vs. +7.9 &plusmn; 9.2; p=0.017).&nbsp;Kaplan&ndash;Meier analyses showed lower cumulative incidence of HF-related and all-cause hospitalizations, as well as fewer emergency department visits, in the intervention group, although without statistical significance at 3 months (p=0.10) (figure 1). Mortality was 0 in the intervention group and 2 in the control group.&nbsp;</span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:&quot;Times New Roman&quot;,serif"><strong><span style="font-size:11.0pt"><span style="font-family:&quot;Calibri&quot;,sans-serif">Conclusions:</span></span></strong><span style="font-size:11.0pt"><span style="font-family:&quot;Calibri&quot;,sans-serif"> Early post-discharge ambulatory CR appears safe and demonstrates clinically meaningful improvements in functional capacity and quality of life, with encouraging early signals toward reduction in hospitalizations. Long-term results from the planned 2-year follow-up may clarify its impact on major clinical endpoints and support its implementation in centers without established center-based CR programs.</span></span></span></span></p>