EARLY cardiac rehabilitation for critically ill patients with acute decompensated heart failure did not significantly improve physical function or reduce rehospitalisation compared to usual care, according to a randomised clinical trial, though some mobility benefits were observed in the intervention group.
Acute decompensated heart failure (ADHF) is a leading reason for admission to cardiac intensive care units, where patients are at risk of declining mobility and lengthy hospital stays. Given this ongoing challenge, there has been growing interest in whether starting a personalised cardiac rehabilitation programme early during the intensive care phase could improve patient outcomes and reduce later complications, yet evidence remains limited.
In a single-centre, single-blind randomised clinical trial from China, 120 patients with severe ADHF, averaging 68.6 years of age and mostly male, were recruited between March 2021 and September 2022. Participants were randomly assigned to receive either an early, progressive cardiac rehabilitation programme during their intensive care stay or usual care. Researchers measured Short Physical Performance Battery (SPPB) scores at hospital discharge alongside six-month all-cause rehospitalisation rates. Statistical analysis showed no significant difference between the groups in SPPB scores, with a median score difference of 1.0 (95% CI 0-2.0, P=0.16). Six-month rehospitalisation rates were also similar at 28.3% for the intervention group and 26.6% for controls (hazard ratio 1.00, 95% CI 0.51-1.99, P=0.99). However, the intervention group did achieve better Perme ICU Mobility scores, with a median group difference of 2.76 (adjusted P=0.04), suggesting enhanced mobility.
While early cardiac rehabilitation did not lead to significant improvements in SPPB scores or prevent rehospitalisation, the findings indicate possible gains in patient mobility that could be beneficial in clinical practice. Further research is needed to clarify which subgroups may benefit most and to explore whether improvements in mobility translate into other meaningful health outcomes. Clinicians should consider individual patient needs and functional status when integrating rehabilitation programmes into intensive care routines.
Reference
Wu L et al. Early cardiac rehabilitation for critically ill patients with acute decompensated heart failure: a randomized clinical trial. JAMA Netw Open. 2025;8(7):e2524141.
