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Background: The REHAB-HF (Rehabilitation Therapy in Older Acute Heart Failure Patients) trial demonstrated that a transitional, tailored, progressive rehabilitation intervention improved physical function, 6-minute walk distance, frailty, quality-of-life, and depression in older patients hospitalized for acute decompensated heart failure. This analysis assessed the impact of atrial fibrillation (AF) on intervention benefits., Methods and Results: Of 349 enrolled patients hospitalized for acute decompensated heart failure (mean age 72.7±8.1 years), 176 (50.4%) had AF. Participants were randomly assigned to 12-week rehabilitation intervention or attention control. The primary outcome was Short Physical Performance Battery score at 3 months. Participants with AF were older (74.4±8.3 versus 70.8±7.5, P <0.0001) and had higher prevalence of heart failure with preserved ejection fraction (58.5% versus 47.4%, P =0.037). Patients with and without AF had similar improvement in Short Physical Performance Battery score (mean difference between rehabilitation intervention and attention control, 1.5 [95% CI, 0.6-2.3] versus 1.5 [95% CI, 0.7-2.3]; P <0.001). Those with AF had significant improvement in 6-minute walk distance (all P <0.05) and each of the Short Physical Performance Battery domains: balance, 4-meter walk, and chair rise. Kansas City Cardiomyopathy Questionnaire score significantly improved in patients with AF ( P <0.05) but not those without AF ( P >0.05). Interaction P values for 3-month outcomes by AF status were not significant ( P >0.1). No significant differences were observed in deaths, all-cause rehospitalizations, or heart failure hospitalizations at 6 months., Conclusions: In older, hospitalized patients with acute decompensated heart failure, the presence of AF did not significantly affect the benefit of the rehabilitation intervention on physical function and quality of life. The intervention appears safe and effective regardless of AF status., Registration: URL: https://www.clinicaltrials.gov; Unique Identifier: NCT02196038.

Objective: Despite an equal willingness to participate in clinical trials, there is evidence that several minority populations are systematically under-represented in studies. One potential cause and frequently used exclusionary criterion in orthopedic trials is patients with active workman's compensation (WC) insurance claims. The purpose of this study is to determine demographic differences in patients undergoing arthroscopic rotator cuff repair with commercial and government insurance vs workers compensation claims., Methods: This was a retrospective review of patients who underwent primary arthroscopic rotator cuff repair at a single institution in the northeastern United States from 2018 to 2019. Patients undergoing revision cases were excluded. Chart review was used to extract demographic data such as age, gender, insurance, and reported race., Results: A total of 4553 patient records were reviewed and included. There were 742 WC patients and 3811 non-WC patients. Two hundred and forty-four patients did not report their race. Overall, WC patients differed from non-WC with respect to race ( P  < 0.001). One hundred and eleven (15.0%) of WC and 293 (7.7%) non-WC patients reported being 'Black' or 'African American' ( P  = 0.002). This compares to 368 (49.6%) WC and 2788 (73.2%) non-WC patients who reported 'White' ( P  < 0.001). About 16.8% of WC patients were identified as 'Hispanic or Latino,' compared to 5.2% of non-WC ( P  < 0.001)., Conclusion: African American and Hispanic/Latino patients are over-represented in workman's compensation patient populations relative to non-workman's compensation. Conversely, white patients are over-represented in non-WC patient populations, which serve as the basis for the majority of clinical study populations. Excluding workman's compensation patients from clinical trials may lead to an underrepresentation of African American and Hispanic/Latino patient populations in orthopedic clinical trials. In doing so, the generalizability of the results of rotator cuff repair clinical outcomes research to all races and ethnicities may be compromised.

Background: Pulmonary Hypertension (PH) is a sequela of arteriovenous (AV) fistulas (AVF) or AV grafts (AVG) in patients with end-stage kidney disease (ESKD) due to the creation of shunt physiology and increased pulmonary blood flow. PH has been consistently associated with increased mortality but there is a paucity of data regarding management., Research Question: The objective of this study was to identify risk factors and outcomes in patients who develop PH after AVF or AVG creation for hemodialysis access., Methods: Using the United States Renal Data System, we identified all patients over age 18 initiated on dialysis from 2012-2019 who did not receive renal transplant. We identified a) the predictors of PH in patients with ESKD on hemodialysis; b) the independent mortality risk associated with development of PH., Results: We identified 478,896 patients initiated on dialysis from 2012-2019 of whom 27,787 (5.8 %) had a diagnosis of PH. The median age was 65 (IQR: 55-74) years and 59.1 % were male. Reduced ejection fraction, any congestive heart failure, obstructive sleep apnea, and female sex were the strongest predictors of PH diagnosis. Both AVG and AVF were also associated with an increased rate of PH diagnosis compared to catheter-based dialysis (p < 0.001). PH portended a poor prognosis and was associated with significantly increased mortality (p < 0.001)., Conclusions: Patients with AVF or AVG should be screened using echocardiography prior to creation and monitored with serial echocardiography for the development of PH, and if present, considered for revision of the AVA. This is also the first study to identify that AVG are a risk factor for PH in dialysis patients., Competing Interests: Declaration of competing interest We have no conflicts of interest to disclose., (Copyright © 2024. Published by Elsevier Inc.)