(159) Impact of a Rehabilitation Program in Patients With Impella Waiting for a Heart Transplant

Introduction: The physical condition of patients awaiting cardiac transplantation significantly impacts outcomes. The Impella device enhances cardiac output, improving nutrient absorption and enabling the initiation of a rehabilitation program. This study assessed the relationship between mobility status measured with the Activity Measure for Post-Acute Care (AM-PAC) prior to transplant and Days Alive Outside Hospital within 30 days after transplant (DAOH-30), as well as the relationship between hours in physical therapy during hospitalization prior to transplant and the improvement in the AM-PAC score.

Methods: This retrospective cohort study includes 90 patients who received heart transplants and had an Impella device before transplant, between December 2019 and October 2023. The AM-PAC scores were measured by a physical therapist at hospital admission, before and after the heart transplant. The relationship between AM-PAC score and DAOH-30 was evaluated using quantile regression due to the non-linearity of DAOH-30. Additionally, the association between the number of physical therapy (PT) hours prior to transplant and the improvement in AM-PAC score from hospital admission to pre-transplant was evaluated using linear regression.

Results: We included 90 patients who performed physical rehabilitation with Impella devices before a heart transplant. The overall mortality rate was 6% (n = 5) and average age upon admission was 57 years (SD 12) and the median NYHA class at admission was 4. Quantile regression confirmed that each one-point improvement in AM-PAC Mobility scores corresponded to an increase of 0.28 days (95% CI: 0.2, 0.55; p=0.03) in DAOH-30. Additionally, each additional PT hour prior to heart transplant was associated with a significant increase of 1.07 points (95% CI: 0.1, 2; p=0.03) in standardized AM-PAC Mobility scores measured pre-transplant.

Conclusions: Extended PT is positively associated with improved AM-PAC Mobility scores and increased hospital-free days in patients with Impella devices awaiting heart transplant. These findings highlight the benefits of comprehensive rehabilitation in enhancing functional mobility and reducing hospital stays during the post-transplant period.