Worsening Physical Function during Hospitalization is Associated with Poor Outcome in Patients with Acute Decompensated Heart Failure

Abstract

Introduction: Recently, some reports indicated the marked impairment of physical function in patients with acute cardiac disease. In addition, further deterioration in physical activity is found during hospitalization especially in elderly patients, which may be associated with poor outcome after discharge. In this study, we measured gait speed (GS), which is a useful parameter in assessment of physical function, repeatedly during hospitalization, and evaluated the association of the change in GS with mortality after discharge. Hypothesis: Worsening physical function during hospitalization is associated with poor outcome in patients with heart failure. Methods: We examined 445 patients with acute decompensated heart failure who underwent cardiac rehabilitation from January 2015 to October 2017 (243 males, 80 years). 10m walking test for measuring GS were performed at the beginning of training (1st time point) and before discharge (2nd time point). We also evaluated respiratory function with spirometry and nutrition status with CONUT score (controlling nutritional status) at the beginning of training. We conducted cardiac rehabilitation with daily 20-min session consisted of walking training and functional strength training focused on lower extremities. Results: Among subjects, 82 patients (18%) had decline in GS even after training. In multivariable logistic regression analysis, forced vital capacity, CONUT score, activity of daily living (ADL) before admission and age were associated with decline in GS during hospitalization. Decline in GS was significantly associated with cadiovascular mortality during 3 years after discharge (log-rank test, p=0.041). In cox regression analysis, decline in GS was associated with cardiovascular mortality after adjustment for age and gender (HRs 2.430, 95%CI 1.222 to 4.833, p=0.011). Conclusion: Worsening physical function during hospitalization is associated with poor outcome in patients with acute decompensated heart failure.