Safety of Early Rehabilitation for Acute Heart Failure Using Japanese Medical Claims

The safety of initiating early physical rehabilitation therapy and its optimal load in patients with acute decompensated heart failure (ADHF) remain unclear. This study evaluated the safe timing and load of early rehabilitation therapy for patients with ADHF.

In this cohort study using nationwide medical claims data from Japan, we included patients aged ≥18 years who were admitted for ADHF and received in-hospital rehabilitation therapy for at least 2 days within the first 4 days of admission between 2016 and 2020. Nine hypothetical treatment regimens within the first 7 days of admission, varying in timing, duration, and load were used as exposures. The outcome was the cumulative incidence of adverse events (eg, death) within 30 days after admission. A per-protocol analysis was conducted using a target trial emulation framework with a sequential doubly robust estimator.

Altogether, 10 179 patients with ADHF were enrolled, with 752 developing adverse events (incidence 7.39%). The lowest incidence rate (4.13%) was observed in the regimen where therapy was initiated on the first day of admission with 20 minutes of therapy, continuing for up to 7 days (95% CI, 3.30-4.95). Conversely, the highest incidence rate was observed in the regimen where therapy was initiated on the third day of admission with 40 minutes of therapy, continuing for up to 7 days (8.67% [95% CI, 8.22-9.13]).

Very early, low-load rehabilitation therapy for patients with ADHF may reduce the risk of adverse events. These findings suggest important implications in the implementation of early rehabilitation.