Bridging the post-hospitalization gap: a feasibility study of home-based rehabilitation in decompensated heart...

Patients hospitalized with acute decompensated heart failure (ADHF) often experience impaired physical function, reduced quality of life (QoL), and loss of independence. While current guidelines recommend rehabilitation, structured programmes are lacking in Germany. Thus, this trial focuses on the feasibility of a structured, home-based rehabilitation programme in pre-frail and frail patients recently hospitalized for ADHF.

The Pilot-CRHF (trial registry number: NCT06269263) study is a monocentric, single-arm prospective interventional study including multidimensional home-based exercises targeting endurance, strength, and balance. Adherence rate, physical function (6-minute walk test [6MWT], timed-up-and-go [TUG], Berg-Balance-Scale [BBS]) and QoL (Kansas City Cardiomyopathy Questionnaire [KCCQ]) were assessed at baseline and after 12 weeks of intervention.

30 patients (mean age 79 ± 8; 40% female; 87% NYHA III or IV) were enrolled between March, 2024 and January, 2025. Among those, 43% had heart failure with preserved ejection fraction and 57% left ventricular ejection fraction (LVEF) <50%. 24 patients (80%) completed the programme. After 12 weeks, 6MWT distance improved significantly (220 ± 134 m vs 308 ± 147 m; P < .001). TUG improved only in patients with LVEF <50% (12.1 ± 5.0 s vs 9.7 ± 4.9 s; P = .04). BBS remained unchanged. QoL improved significantly (KCCQ: 56 ± 16 vs 75 ± 19; P < .001).

Home-based rehabilitation is feasible leading to clinically meaningful improvements in physical function and QoL in pre-frail and frail heart failure patients, particularly those with LVEF. The results support further evaluation in a larger randomized trial.