Kitamura M1,2,3, Izawa P K2,3, Yaekura M4, Mimura Y4, Nagashima H4
1Kokura Rehabilitation College, Department of Physical Therapy, Kitakyushi, Japan, 2Kobe University, Department of Public Health, Graduate School of Health Sciences, Kobe, Japan, 3Cardiovascular Stroke Renal Project (CRP), Kobe, Japan, 4Shinyukuhashi Hospital, Department of Rehabilitation, Yukuhashi, Japan
Background: Preventing early readmission of heart failure (HF) patients is important for prognosis and medical costs. Activities of daily living (ADL) in HF patients are reported to be associated with readmission, and nutrition is known to be associated with prognosis. However, the relation of early readmission with ADL and nutrition in HF patients has not been well studied.
Purpose: We aimed to clarify the relation between readmission within 90 days and ADL and nutrition in elderly HF patients.
Methods: This was a cohort study comprising 643 consecutive patients with HF who underwent cardiac rehabilitation in one acute-phase hospital from May 2012 to November 2016. Inclusion criteria were patients aged 65 years and older with first hospitalization who were ambulatory prior to admission. Patients who had pacemaker surgery, were difficult to communicate with or follow up, were transferred or died during hospitalization, and were not discharged to home were excluded. We investigated patient characteristics, basic attributes, ADL (with the motor and cognitive items of the Functional Independence Measure: FIM), and nutrition (with the Geriatric Nutritional Risk Index: GNRI). We analyzed the data with the unpaired t-test, χ2 test, Cox proportional hazard model, and Kaplan-Meier method.
Results: Of the 634 patients, 170 met the inclusion criteria and were divided into two groups (readmission group, n=31; non-readmission group, n=139). Body mass index, hemoglobin, GNRI and motor-FIM were significantly different between the two groups (p 0.05). After proportional Cox hazard model analysis, GNRI (HR: 0.96; p 0.05) and motor-FIM (HR: 0.97; p 0.05) scores remained statistically significant. The patients were then classified into four groups based on cut-off values of the GNRI and motor FIM as determined in a previous study related to prognosis: GNRI ≥92 and motor FIM ≥75, GNRI ≥92 and motor FIM 75, GNRI 92 and motor FIM ≥75, and GNRI 92 and motor FIM 75. As a result, the readmission avoidance rate by Kaplan-Meier method was significantly lower (p 0.05) in the group with GNRI 92 and motor-FIM 75 points.
Conclusion(s): In this study, motor-FIM and GNRI scores for hospitalized elderly HF patients were predictors of readmission within 90 days. When the scores for these two items were below the abovementioned cut-off values, rates of readmission were high.
Implications: Our results may help to prevent readmission by improving nutrition and ADL in elderly HF patients.
Keywords: Activities of daily living, Heart failure, Nutrition
Funding acknowledgements: This work was supported by JSPS KAKENHI [grant number JP17K01500] and by the MEXT-Supported Program [grant number S1511017]
Purpose: We aimed to clarify the relation between readmission within 90 days and ADL and nutrition in elderly HF patients.
Methods: This was a cohort study comprising 643 consecutive patients with HF who underwent cardiac rehabilitation in one acute-phase hospital from May 2012 to November 2016. Inclusion criteria were patients aged 65 years and older with first hospitalization who were ambulatory prior to admission. Patients who had pacemaker surgery, were difficult to communicate with or follow up, were transferred or died during hospitalization, and were not discharged to home were excluded. We investigated patient characteristics, basic attributes, ADL (with the motor and cognitive items of the Functional Independence Measure: FIM), and nutrition (with the Geriatric Nutritional Risk Index: GNRI). We analyzed the data with the unpaired t-test, χ2 test, Cox proportional hazard model, and Kaplan-Meier method.
Results: Of the 634 patients, 170 met the inclusion criteria and were divided into two groups (readmission group, n=31; non-readmission group, n=139). Body mass index, hemoglobin, GNRI and motor-FIM were significantly different between the two groups (p 0.05). After proportional Cox hazard model analysis, GNRI (HR: 0.96; p 0.05) and motor-FIM (HR: 0.97; p 0.05) scores remained statistically significant. The patients were then classified into four groups based on cut-off values of the GNRI and motor FIM as determined in a previous study related to prognosis: GNRI ≥92 and motor FIM ≥75, GNRI ≥92 and motor FIM 75, GNRI 92 and motor FIM ≥75, and GNRI 92 and motor FIM 75. As a result, the readmission avoidance rate by Kaplan-Meier method was significantly lower (p 0.05) in the group with GNRI 92 and motor-FIM 75 points.
Conclusion(s): In this study, motor-FIM and GNRI scores for hospitalized elderly HF patients were predictors of readmission within 90 days. When the scores for these two items were below the abovementioned cut-off values, rates of readmission were high.
Implications: Our results may help to prevent readmission by improving nutrition and ADL in elderly HF patients.
Keywords: Activities of daily living, Heart failure, Nutrition
Funding acknowledgements: This work was supported by JSPS KAKENHI [grant number JP17K01500] and by the MEXT-Supported Program [grant number S1511017]
Topic: Cardiorespiratory; Disability & rehabilitation; Older people
Ethics approval required: Yes
Institution: Kokura Rehabilitation College
Ethics committee: Kokura Rehabilitation College Ethics Committee
Ethics number: approval number 29-03
All authors, affiliations and abstracts have been published as submitted.
