EACH-ADHF: Early Comprehensive Rehabilitation in Patients With ADHF

Study Overview
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Brief Summary
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EACH-ADHF: Early Comprehensive Rehabilitation in patients with ADHF study is a multi-center, parallel-group, randomized controlled trial designed to evaluate the effects of the early comprehensive rehabilitation including exercise and inspiratory muscle training, over a period of 6 weeks, on the quality of life of patients with ADHF.

Detailed Description
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Guangdong Provincial People's Hospital will be the lead center, with an additional 12 hospitals designated as satellite centers for the study. To sum up, these centers will recruit a total of 140 consenting patients. Following informed consent and baseline testing, the participants will be randomized in a 1:1 fashion to receive a 6-week progressive, comprehensive exercise training and inspiratory muscle training or attention control. The intervention group will receive an 6-week exercise program consisting of endurance, resistance, balance, mobility, and inspiratory muscle training. The comprehensive rehabilitation will begin during the patient's stay and continue to the outpatient clinic. The control group will receive usual care with bi-weekly contact from study personnel. The primary outcomes of the study are improvements in the summary score of KCCQ and PImax%pred, while secondary endpoints include the impact on physical function, cardiac function, psychological status, and major adverse cardiovascular events (MACE). Additionally, the study will also explore the effects of comprehensive rehabilitation on hospital readmission and mortality rates, with follow-up assessments planned up to 6 months after discharge.

Official Title
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Efficacy and Safety of Early Comprehensive Rehabilitation in Patients With ADHF, A Multicenter, Randomized, Controlled Trial.

Conditions
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Acute Decompensated Heart Failure

Intervention / Treatment
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* Behavioral: Early comprehensive rehabilitation


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Age between 18-80 At least one symptom of heart failure upon admission: Dyspnea at rest or with exertion, orthopnea, paroxysmal nocturnal dyspnea or exertional fatigue. At least two of the signs of heart failure (HF): Distended jugular veins, enlarged cardiac silhouette, apex beat displacement, third heart sound, or increased jugular venous pressure/central venous pressure/pulmonary capillary wedge pressure. Pulmonary edema or pulmonary congestion (rales or chest X-ray/CT evidence of pulmonary congestion). Peripheral edema. Elevated B-type natriuretic peptide (>100 pg/ml) or elevated NT-proBNP (>300 pg/ml). Able to independently perform basic activities of daily living before admission. Able to complete the baseline assessment and initiate the specified treatment. Able to walk 4 meters at the time of enrollment (assistive devices may be used). Agree to participate in this study, sign a written informed consent form, and is willing to cooperate with follow-up. Exclusion Criteria: Acute heart failure caused by acute myocardial infarction. Severe aortic valve stenosis. Hemodynamic instability caused by poorly controlled arrhythmias. Severe heart failure and high-degree atrioventricular block, and inadequate heart rate response to pacing during exercise. Isolated pulmonary hypertension. Poorly controlled symptomatic orthostatic hypotension. Hypertrophic obstructive cardiomyopathy. Stage 5 chronic kidney failure, defined as glomerular filtration rate <15 ml/(min·1.73m²) or requiring dialysis. Undergoing screening tests with alanine aminotransferase (ALT) or aspartate aminotransferase (AST) levels greater than or equal to 5 times the upper limit of the normal range defined by the center. Awaiting a heart transplant or ventricular assist device implantation within six months, or having received a heart transplant. A history of chronic lung disease except for COPD, previous lung surgery, or diseases affecting lung function, such as scoliosis. Late-stage diseases other than heart failure. Any medical history that could potentially affect protocol compliance, such as severe mental disorders, severe cognitive impairment, substance abuse, or addiction. Severe language, psychological, or physical disabilities that prevent their participation in the program. Pregnant or lactating women, or those of childbearing potential who are unwilling or unable to use effective contraceptive measures. Involved in other interventional clinical trials. Patients deemed unfit for participation in this study by the researchers.

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 80 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: Rehabilitation Intervention Group<br>Comprehensive rehabilitation plan containing 18 sessions of a structured exercise and inspiratory muscle training program over 6 weeks (3 times per week). | Behavioral: Early comprehensive rehabilitation<br>* Patients randomized to the rehabilitation intervention group will be offered comprehensive rehabilitation plan containing 18 sessions of a structured outpatient-based exercise program over 6 weeks (3 times per week).<br>|
| No Intervention: Attention Control<br>Conventional care with bi-weekly contact from study personnel. | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Score of Quality of Life Measured by Kansas City Cardiomyopathy Questionnaire (KCCQ) | The Kansas City Cardiomyopathy Questionnaire (KCCQ) is a self-administered, 23-item questionnaire that quantifies physical limitations, symptoms, self-efficacy, social interference and quality of life. All scores are represented on a 0-to-100-point scale, where lower scores represent more severe symptoms and/or limitations and scores of 100 indicate no symptoms, no limitations, and excellent quality of life. | Baseline and Week 6 | 
| Maximal Inspiratory Pressure as a Percentage of Predicted Value (PImax%pred) | Participants will tries their best to exhale to the residual position, and then inhale as much as possible for 2 3 seconds to measure PImax and the percentage of PImax%pred | Baseline and Week 6 | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Score of Short Physical Performance Battery (SPPB) | The SPPB measures physical function using 3 components: standing balance with progressively narrow base of support, usual gait speed over 4 meters, and time to complete 5 chair rises. The total score ranges from 0 to 12, with higher scores indicating better physical function. | Baseline and Week 6 | 
| Score of Frailty | Patients were classified as frail if they met three or more of the following criteria: weak grip strength, physical exhaustion, slowness, low physical activity and unintentional weight loss. | Baseline and Week 6 | 
| Pulmonary Function | Measurements of forced vital capacity and forced expiratory volume in 1 s were obtained with a computerized spirometer. | Baseline and Week 6 | 
| Rate of All-Cause Rehospitalization | Number of all-cause rehospitalizations 6 months from hospital discharge. | Month 6 | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Acute decompensated heart failure, Early comprehensive rehabilitation, Inspiratory muscle training, Exercise training, KCCQ