Abstract
BACKGROUND: A multidomain physical rehabilitation intervention (REHAB-HF [Rehabilitation Therapy in Older Acute Heart Failure Patients] intervention) has been associated with significant improvements in physical function and quality of life (QOL) among older patients with acute decompensated heart failure (ADHF). OBJECTIVES: This study aims to evaluate sex differences in the treatment effect of a multidomain rehabilitation intervention among participants of the REHAB-HF trial. METHODS: In this prespecified secondary analysis of the REHAB-HF trial, sex differences in the treatment effect of the REHAB-HF intervention (vs attention control) on key 3-month outcomes of the Short Physical Performance Battery (SPPB, primary), frailty burden, 6-minute walking distance (6MWD), and QOL were assessed. Statistical significance for treatment effect interaction (sex∗intervention) was set at 0.1. RESULTS: Among the 349 trial participants, female patients (n = 183) had a significantly lower baseline SPPB score and 6MWD and a higher frailty burden than male patients (n = 166). Female (vs male) participants had a significantly greater improvement in SPPB (effect size: 1.9 [95% CI: 1.1-2.7] vs 1.0 [95% CI: 0.1-1.8]; P for interaction = 0.1) and frailty burden, as assessed by Fried phenotype criteria (effect size: -0.5 [95% CI: -0.9 to -0.2] vs 0.00 [95% CI: -0.4 to 0.4]; P for interaction = 0.04) with the REHAB-HF intervention. The magnitude of the improvement in 6MWD and QOL (Kansas City Cardiomyopathy Questionnaire score) with the REHAB-HF intervention was also greater among female (vs male) participants without a significant treatment effect interaction by sex. There was no significant difference in rates of adverse clinical outcomes associated with the intervention across both sex groups. There was no difference in intervention adherence by sex. CONCLUSIONS: Female (vs male) participants with ADHF had a significantly greater improvement in physical function in response to the REHAB-HF intervention.