Hospitalization-associated disability increases one-year mortality in older patients with heart failure: Findings from the J-Proof HF registry

Koji Sakurada, Masakazu Saitoh, Tomoyuki Morisawa, Kentaro Kamiya, Yuji Kono, Masanobu Taya, Kentaro Iwata, Yoshinari Funami, Tetsuya Takahashi, Kazuya Kito, Eiji Nakatani, Michitaka Kato
Purpose:

This study aimed to clarify the effect of HAD on post-discharge prognosis in older patients with heart failure (HF).

Methods:

This study included 6,519 patients who were independent in ADL before hospitalization from the J-Proof HF registry, which is a study conducted by the Japanese Society of Cardiovascular Physical Therapy. HAD was defined as a decrease of ≥ 5 points in the Barthel index (BI) at discharge compared to the pre-hospitalization BI in a stable condition. Subgroup analyses classified HAD as mild (a decrease in the BI of 5 to 15 points) and severe (a decrease in the BI of ≥ 20 points). The primary outcome was all-cause mortality within one year post-discharge, whereas the secondary outcomes were HF-related mortality and HF rehospitalization.

Results:

All-cause mortality, heart failure-related mortality, and HF rehospitalization rates within one year were 12%, 5%, and 22%, respectively. Multivariate Cox regression analysis revealed that patients with HAD had a significantly higher risk of all-cause and HF-related mortality within one year post-discharge than those without HAD (hazard ratio [HR]; 1.713, P 0.001, HR; 1.556, P 0.001). No significant association was found between HAD and HF readmission. Patients with severe HAD had a significantly higher risk of all-cause mortality within one year than those with mild HAD (HR; 1.388, P 0.001).

Conclusion(s):

The development of HAD was identified as a significant risk factor for mortality within one year post-discharge in older patients with HF who were independent in ADL before hospitalization.

Implications:

In clinical practice, preventing decline in ADL through physical therapy may contribute to prolonging the prognosis of heart failure patients after discharge.

Funding acknowledgements:
This work was supported by research funding of Japanese Society of Cardiovascular Physical Therapy.
Keywords:
Hospitalization-associated disability
mortality
heart failure
Primary topic:
Cardiorespiratory
Second topic:
Disability and rehabilitation
Third topic:
Older people
Did this work require ethics approval?:
Yes
Name the institution and ethics committee that approved your work:
This study was approved by the Ethics Committee of the Juntendo University School of Health Sciences, Tokyo, Japan.
Provide the ethics approval number:
19-005
Has any of this material been/due to be published or presented at another national or international conference prior to the World Physiotherapy Congress 2025?:
No

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