The purpose of this study was to investigate the factors influencing independent walking at hospital discharge in patients aged ≥ 90 years with heart failure.
We enrolled 144 patients aged ≥ 90 years with heart failure who underwent cardiac rehabilitation during hospitalization and were able to walk independently before admission. We investigated whether they were able to walk independently at hospital discharge based on a score of ≥ 5 on the walking item of the Functional Independence Measure. In addition, age, blood test data, echocardiographic data, Geriatric Nutritional Risk Index (GNRI), Clinical Frailty Score (CFS), and the number of days until starting sitting, standing, and walking training from admission were retrospectively investigated.
The mean age of the patients was 93.3±2.7 years. At discharge, 95 patients had independent walking (IW), and 49 had difficulty walking (DW). Comparative analysis between the two groups showed that the factors with significant differences were: age (IW: 92.5±2.2 vs. DW: 94.0±2.9 years, p=0.003), GNRI (IW: 84.1±13.0 vs. DW: 73.2±18.8, p=0.002), hemoglobin (IW: 10.9±1.9 vs. DW: 10.1±1.8 g/dL, p=0.021), C-reactive protein (IW: 1.65±2.48 vs. DW: 3.85±5.12 mg/dL, p=0.010), CFS (IW: 5 [4-6] vs. DW: 6 [5-8], p0.001), the number of days until starting standing training from admission (IW: 4.8±7.7 vs. DW: 14.8±14.6 days, p=0.014), the number of days until starting walking training from admission (IW: 7.7±9.0 vs. DW: 25.0±17.1 days, p0.001). NT-pro BNP (IW: 5269.4±12311.3 vs. DW: 3117.4±7657.5 pg/mL, p0.215) and Left ventricular ejection fraction (LVEF) (IW: 45.9±12.2 vs. DW: 47.1±12.2 %, p0.660) were not significantly different. Multivariate logistic regression analysis showed that GNRI (odds ratio [OR] =1.04, 95% confidence interval [95% CI] =1.01-1.07, p=0.048) and the number of days until starting standing training from admission (OR =0.94, 95% CI =0.87-0.99, p=0.049) were obstructive factors for walking ability at hospital discharge. ROC analysis showed that the cut-off value of the number of days until starting standing training from admission was 3 days (area under the curve=0.83, sensitivity=0.72, specificity=0.88) to predict walking ability at hospital discharge.
The factors influencing independent walking at hospital discharge in elderly patients aged ≥ 90 years with heart failure were GNRI and the number of days until starting standing training. However, this was a single-center retrospective study, and further investigation is required.
Our findings suggest that early standing training and nutritional status may contribute to independent walking at hospital discharge in patients aged ≥ 90 years with heart failure.
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