Humans

Early physical therapy links to lower mortality in heart failure

Early outpatient physical therapy was associated with lower 1-year all-cause mortality than no therapy, with a hazard ratio of 0.46.

Journal of Clinical Medicine4 Oct 2026, 09:00 BST

Researchers analyzed 6,359 older adults hospitalized for worsening heart failure and chronic kidney disease across 96 institutions in Japan. All participants survived without cardiovascular rehospitalization for 30 days post-discharge. Among them, 244 patients began outpatient physical therapy within 30 days. Investigators created 244 propensity score-matched pairs to compare outcomes against patients without documented outpatient therapy. Over 1 year of follow-up, early outpatient physical therapy was associated with lower all-cause mortality (hazard ratio, 0.46; 95% confidence interval, 0.22–0.97). It was also linked to a lower hazard of the composite outcome of death or cardiovascular rehospitalization (hazard ratio, 0.67; 95% confidence interval, 0.48–0.94). The association with cardiovascular rehospitalization alone was not statistically significant.

Why it matters

Older adults with concurrent heart failure and kidney dysfunction experience accelerated functional decline and high mortality. These findings suggest that early exercise-based rehabilitation after hospital discharge may help preserve survival in frail, multimorbid older populations.

Caveats

Because this study was retrospective and observational, it cannot establish a causal effect, and residual confounding or treatment selection bias may exist. In addition, chronic kidney disease was defined from a single hospitalization without longitudinal confirmation, and exact physical therapy exercise doses were not recorded.