Eriksen S1
1St George's University Hospital NHS Foundation Trust, London, United Kingdom
Background: Acute heart failure (AHF) is the most common cause of admissions for patients aged 65 and over in the UK. The occurrence of functional decline in elderly adults with hospitalisation for acute illness is well established with decline occurring as early as day 2 of admission. With an average length of stay of 18.7 days, patient age of 71.4 years, and 77.1% of patients having at least one other chronic disease, the patients admitted to the Heart Failure Unit at St George's Hospital are high risk for functional decline throughout their stay. Traditionally these patients would not be seen by a physiotherapist until after their intravenous diuretic treatment was completed.
Purpose: The aim was to assess the impact of early and specialist physiotherapy assessment and intervention on functional decline during hospitalisation of patients with AHF.
Methods: The Elderly Mobility Scale (EMS) was used to assess function on both admission and discharge from the HFU for 153 patients between March 2016 and October 2017. Patients were provided with individualised physiotherapy intervention whilst an inpatient aimed at preventing functional decline, planning for discharge, and promoting rehabilitation and self-management. Data sets were analysed for normality with the Shapiro-Wilk test and compared using the Wilcoxon signed ranks test. Data on admission date to both discharge and first assessment by physiotherapy were collected.
Results: The average length of stay was 14.59 days. Patients waited for physiotherapy an average of 0.98 days. Patient EMS scores increased significantly (p 0.001) from admission (Mdn 14.00: IQR 11.00-18.00) to discharge (Mdn 16.00: IQR 13.00-18.00).
From admission to discharge the number of patients scoring less than 10, indicating they would need a high level of help with mobility and ADLs, decreased from 30 to 9. The number of patients scoring 10-13, indicating borderline in terms of safe mobility and independence, decreased from 42 to 36. The number of patients scoring 14 to 20, indicating independence with mobility and ADLs, increased from 81 to 108. Seven patients (5%) had a decrease, seventy-four patients (48%) showed no change and seventy-two patients (47%) had an increase in their EMS score on discharge compared with admission.
Conclusion(s): Early physiotherapy intervention for patients hospitalised with acute heart failure appears to significantly improve their function from admission to discharge as assessed by a change in their EMS score. The EMS has been shown to be responsive to change and the minimally clinical significant difference for the EMS estimated at 2 points. Only a small percentage of patients scored lower on discharge than admission and the dependence level of the patients decreased during their stay. Physiotherapy intervention appears beneficial to increase mobility, and decrease dependence, of a predominantly elderly population with multiple comorbidities who are at high risk of functional decline when admitted to hospital in acute heart failure.
Implications: The expected benefits include reduced reliance on care and improved quality of life in the community on discharge. This information is useful for commissioning of new or evolving acute heart failure services to ensure appropriate therapeutic representation.
Keywords: Early intervention, Acute heart failure, Inpatient rehabilitation
Funding acknowledgements: This work was unfunded
Purpose: The aim was to assess the impact of early and specialist physiotherapy assessment and intervention on functional decline during hospitalisation of patients with AHF.
Methods: The Elderly Mobility Scale (EMS) was used to assess function on both admission and discharge from the HFU for 153 patients between March 2016 and October 2017. Patients were provided with individualised physiotherapy intervention whilst an inpatient aimed at preventing functional decline, planning for discharge, and promoting rehabilitation and self-management. Data sets were analysed for normality with the Shapiro-Wilk test and compared using the Wilcoxon signed ranks test. Data on admission date to both discharge and first assessment by physiotherapy were collected.
Results: The average length of stay was 14.59 days. Patients waited for physiotherapy an average of 0.98 days. Patient EMS scores increased significantly (p 0.001) from admission (Mdn 14.00: IQR 11.00-18.00) to discharge (Mdn 16.00: IQR 13.00-18.00).
From admission to discharge the number of patients scoring less than 10, indicating they would need a high level of help with mobility and ADLs, decreased from 30 to 9. The number of patients scoring 10-13, indicating borderline in terms of safe mobility and independence, decreased from 42 to 36. The number of patients scoring 14 to 20, indicating independence with mobility and ADLs, increased from 81 to 108. Seven patients (5%) had a decrease, seventy-four patients (48%) showed no change and seventy-two patients (47%) had an increase in their EMS score on discharge compared with admission.
Conclusion(s): Early physiotherapy intervention for patients hospitalised with acute heart failure appears to significantly improve their function from admission to discharge as assessed by a change in their EMS score. The EMS has been shown to be responsive to change and the minimally clinical significant difference for the EMS estimated at 2 points. Only a small percentage of patients scored lower on discharge than admission and the dependence level of the patients decreased during their stay. Physiotherapy intervention appears beneficial to increase mobility, and decrease dependence, of a predominantly elderly population with multiple comorbidities who are at high risk of functional decline when admitted to hospital in acute heart failure.
Implications: The expected benefits include reduced reliance on care and improved quality of life in the community on discharge. This information is useful for commissioning of new or evolving acute heart failure services to ensure appropriate therapeutic representation.
Keywords: Early intervention, Acute heart failure, Inpatient rehabilitation
Funding acknowledgements: This work was unfunded
Topic: Cardiorespiratory; Service delivery/emerging roles; Primary health care
Ethics approval required: No
Institution: N/A
Ethics committee: N/A
Reason not required: Using the HRA decision tool it was established this work is not research and did not require ethics review. It is an evaluation of the current service only.
All authors, affiliations and abstracts have been published as submitted.
